PRA IC List
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Application to State Exchanges
Modified
114
20706
1480882
DE Entities to Implement Separate Plan Display Requirement
Unchanged
40
800
64032
DE Entities to Implement the Standardized Disclaimer Requirement
Modified
100
400
31324
DE Entity Operational Readiness Review (ORR)
Modified
95
2689
200372
Form and Instruction
CMS-10877
Documentation and Audit Package
Form and Instruction
CMS-10877
Privacy Questiionaire
Instruction
Form and Instruction
CMS-10877
Application User Interface Toolkit
Form and Instruction
CMS-10877
Communications Toolkit
Form and Instruction
CMS-10877
Eligibility Results Toolkit
Form and Instruction
CMS-10877
Eligibility Results Toolkit - Phase 2
Form and Instruction
CMS-10877
Eligibility Results Toolkit - Phase 3
Form and Instruction
CMS-10877
Change Notification Form
Form and Instruction
CMS-10877
Business Agreement BY 2024
Form
CMS-10877
INTERCONNECTION SECURITY AGREEMENT
Form and Instruction
CMS-10877
EDE Communication Toolkit
Form and Instruction
CMS-10877
SAP Template
DE Entity Web-brokers and QHP Issuers to Implement Mandate for HealthCare.gov website Changes
Unchanged
125
3075
245290
Direct Enrollment Entities to Implement Application Assister Requirements
Unchanged
20
15000
1034100
Direct Enrollment Entities to Implement Third-Party Entity Contractual Requirements
Unchanged
25
500
37500
Direct Enrollment Entity Separate Plan Display Exception Requirement
Unchanged
20
400
32016
Issuers to Implement Website Display Requirements for QHPs
Unchanged
75
1500
120060
Web-Brokers to Provide the State Exchange a List of Agents or Brokers
Modified
1040
5000
466960
Web-broker Operational Readiness Reviews (ORR)
Unchanged
20
380
27786
Form and Instruction
CMS-10877
Web-Broker Agreement
Form and Instruction
CMS-10877
Security and Privacy Assessment Reports (SARs) template
Form and Instruction
CMS-10877
Plans of Action and Milestones (POA&Ms) template
Form and Instruction
CMS-10877
System Security and Privacy Plans (SSPs) workbook
Web-broker Website Explanation of Rationale for QHP Recommendations and Methodology for Default Display
Unchanged
20
100
8004
Web-broker Website Required QHP Comparative Information and Enrollment Support Disclaimer
Modified
20
460
40020
Web-brokers to Implement Application to State Exchanges
Modified
20
5100
394620
Web-brokers to Implement the General non-FFE Disclaimer Requirement
Modified
20
80
6264
Web-brokers to Prominently Display Consumer Eligibility Results for Advance Payments of the Premium Tax Credit and Cost-sharing Reductions
Modified
20
100
16008
Total burden requested under this ICR:
1774
56290
4205238
To view an IC, click on IC Title
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.