Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Individual Application Unchanged 11327040 7105452 0 Form and Instruction CMS-10440 Application for Health Coverage & Help Paying Costs (Short Form)
Form and Instruction CMS-10440 Application for Health Coverage & Help Paying Costs
Form and Instruction CMS-10440 Application for Health Coverage (no cost help)
Form CMS-10440 Electronic application.
Form and Instruction CMS-10440 Attachment B - Individual Short Form (Spanish)
Form and Instruction CMS-10440 Attachment C - Marketplace Consumer Application (Spanish)
Form and Instruction CMS-10440 Attachment D - Marketplace Application without Financial Assistance (Spanish)
Total burden requested under this ICR: 11327040 7105452 0  
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