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OMB Control No: 0938-1191	ICR Reference No: 202507-0938-012
Status: Active	Previous ICR Reference No: 202506-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and CHIP Agencies (CMS-10440)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/01/2026
	Date Received in OIRA: 07/09/2025
Terms of Clearance: Prior to the next extension or revision of this ICR, the public burden statement on each instrument shall be updated to include language that provides all of the information required per 5 CFR § 1320.8(b)(3).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2029	36 Months From Approved	09/30/2027
Responses	841,273	0	11,327,040
Time Burden (Hours)	7,095,818	0	7,105,452
Cost Burden (Dollars)	0	0	0

Abstract: Section 1413 of the Affordable Care Act directs the Secretary of HHS to develop and provide to each State a single, streamlined form that may be used to apply for coverage through the Exchange and Insurance Affordability Programs. A state may develop and use its own single streamlined application if approved by the Secretary in accordance with section 1413 and if it meets the standards established by the Secretary.

Authorizing Statute(s): PL: Pub.L. 111 - 148 1413 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 152 1314 Name of Law: Health Care and Education Reconciliation Act of 2010

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1413 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 152 1341 Name of Law: Health Care and Education Reconciliation Act of 2010

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV61	Final or interim final rulemaking	90 FR 27074	06/25/2025

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Individual Application	CMS-10440, CMS-10440, CMS-10440, CMS-10440, CMS-10440, CMS-10440, CMS-10440	, , , , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	841,273	11,327,040	-10,485,767
Annual Time Burden (Hours)	7,095,818	7,105,452	-9,634
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is a total annual application processing burden increase of 2,654,720 hours (from 2,112,493 hours to 4,767,213 hours, a net increase of 2,654,720 hours) for 2026. The burden increase is due to the increase in consumers for whom the Exchange will need to adjudicate income inconsistencies and process SEP verification issues. There is a total annual application processing burden decrease of 570,160 hours (from 2,112,493 hours to 1,542,333 hours) for years after 2026 due to the overall decrease in estimated enrollment and the decrease in consumers for whom the Exchange will need to adjudicate income inconsistencies and process SEP verification issues. There is a total annual consumer burden increase of 2,102,859 hours (from 4,992,959 hours to 7,095,818 hours) for 2026. The burden increase is due to the increase in consumers who will need to gather and submit documents in order to adjudicate income inconsistencies and resolve SEP verification issues. There is a total annual consumer burden decrease of 792,918 hours (from 4,992,959 hours to 4,200,041 hours) for years after 2026 due to the overall decrease in estimated enrollment and the decrease in consumers for whom the Exchange will need to adjudicate income inconsistencies and process SEP verification issues.

Annual Cost to Federal Government: $3,629,229

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Jamaa Hill 301 492-4190

View ICR - OIRA Conclusion