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OMB Control No: 0938-1193	ICR Reference No: 202603-0938-005
Status: Received in OIRA	Previous ICR Reference No: 202301-0938-019
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Data Collection to Support Eligibility Determinations and Enrollment for Small Businesses in the Small Business Health Options Program (CMS-10439)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 03/09/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2026
Responses	2,100	2,100
Time Burden (Hours)	336	336
Cost Burden (Dollars)	0	0

Abstract: On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. 111-152, collectively referred to as "The Affordable Care Act." The Affordable Care Act expands access to health insurance coverage through improvements to the Medicaid and Children's Health Insurance (CHIP) programs, the establishment of Affordable Insurance Exchanges (Exchanges), and the assurance of coordination between Medicaid, CHIP, and Exchanges. Through the Small Business Health Options Program (SHOP), the new Exchanges will assist qualified small employers in facilitating the enrollment of their employees in Qualified Health Plans (QHPs) offered in the small group market. The Exchanges, which will offer these QHPs, will become operational on January 1, 2014. Employers will be able to begin applying for coverage through the SHOP October 1, 2013, for coverage beginning as early as January 1, 2014. The employer's application for the SHOP will be a single, streamlined form that will be used to determine employer eligibility for the SHOP. The submission seeks OMB approval of the data collection elements needed to support eligibility determinations for small businesses in the SHOP.

Authorizing Statute(s): PL: Pub.L. 111 - 148 1311 Name of Law: Affordable Care Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 52408	11/20/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 11321	03/09/2026
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
SHOP - Employer	CMS-10439

ICR Summary of Burden

	Total Request	Previously Approved
Annual Number of Responses	2,100	2,100
Annual Time Burden (Hours)	336	336
Annual Cost Burden (Dollars)	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: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $389

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

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