PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Agent/Broker Eligibility and Consent Documentation
Modified
9800000
1666001
52234000
Form
CMS-10840
CMS Model Consent Form for Marketplace Agents and Brokers
Agent/Broker Eligibility and Consent Records
Modified
600
600
34080
Form and Instruction
CMS-10840
Agent Broker Consent Form
Total burden requested under this ICR:
9800600
1666601
52268080
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