Information Collection Request

Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel - CAC (CMS-10494)

ICR 202210-0938-013 · OMB 0938-1205 · Received in OIRA

Forms and Documents

Document Name	Status
Form CMS-10494 Navigator Requirements for Training Certification Form and Instruction	Unchanged
Form CMS-10494 Certified Counselor Designated Organization (CDO Application) Form and Instruction	Unchanged
Form CMS-10494 Recertification request by organization Form and Instruction	Unchanged
Form CMS-10494 155.225(b)(1) Organization designation by Exchange Information Updates Form and Instruction	Unchanged
Form CMS-10494 155.225(d)(1) and (7) Training Quality Optional Questionnaire Form and Instruction	Unchanged
Form CMS-10494 155.225(d)(1) - Training certificate retention Form and Instruction	Unchanged
Form CMS-10494 155.225(d)(1) - Training certificate proof Form and Instruction	Unchanged
Form CMS-10494 155.225(d)(1) - Training Registration Form and Instruction	Unchanged
Form CMS-10494 155.225(b)(1)(ii) - Identification number record retention Form and Instruction	Unchanged
Form CMS-10494 155.225(b)(1)(ii) - Issuance of unique registration identification number Form and Instruction	Unchanged
Form CMS-10494 155.225(d)(2) and (f) (CAC authorization to consumer) Form and Instruction	Unchanged
Form CMS-10494 155.225(b)(1)(i) (certificate issuance) Form and Instruction	Unchanged
Form CMS-10494 155.225(b)(1) (organization follow-up for application) Form and Instruction	Unchanged
Form CMS-10494 155.225(b)(1) (organization designation by Exchange) Form and Instruction	Unchanged
CMS-10494 - Conflict of Interest Disclosure_ CAC).pdf Supplementary Document	2022-10-25
CMS-10494 - Non Substantive Change Request 508.pdf Justification for No Material/Nonsubstantive Change	2022-10-25
CMS-10494 - Supporting_Statement_March 2022.docx Supporting Statement A	2022-03-02

IC Document Collections

IC ID	Document Title	Status
251934	Navigator Requirements for Training Certification Form and Instruction	Unchanged
241050	Certified Counselor Designated Organization (CDO Application) Form and Instruction	Unchanged
220357	?155.225 (b)(ii) (performance tracking form by organization)	Unchanged
220355	?155.225 (b)(ii) (reporting performance data by certified application counselor)	Unchanged
220354	?155.225 (b)(ii) (recordkeeping performance data by organization)	Unchanged
220353	?155.225 (b)(1)(iii)- (reporting by organizations)	Unchanged
220352	?155.225 (b)(1)(iii)- (review by State Exchange)	Unchanged
220351	?155.225(b)(1)(iii)-(review byFederally-facilitatedExchange)	Unchanged
216275	Recertification Training	Unchanged
216274	Recertification request by organization Form and Instruction	Unchanged
216273	CAC Recertification	Unchanged
216272	155.225(b)(1) Organization designation by Exchange Information Updates Form and Instruction	Unchanged
216271	155.225(d)(1) and (7) Training Quality Optional Questionnaire Form and Instruction	Unchanged
208217	155.225(d)(1) - Training certificate retention Form and Instruction	Unchanged
208216	155.225(d)(1) - Training certificate proof Form and Instruction	Unchanged
208215	155.225(d)(1) - Training Registration Form and Instruction	Unchanged
208214	155.225(b)(1)(ii) - Identification number record retention Form and Instruction	Unchanged
208213	155.225(b)(1)(ii) - Issuance of unique registration identification number Form and Instruction	Unchanged
207940	155.225(d)(2) and (f) (CAC authorization to consumer) Form and Instruction	Unchanged
207939	155.225(d)(2) and (f) (organization record of authorization)	Unchanged
207938	155.225(b)(1)(i) (certificate issuance) Form and Instruction	Unchanged
207937	155.225(b)(1) (organization list)	Unchanged
207874	155.225(b)(1)(i) (organization attestation)	Unchanged
207873	155.225(b)(1) (organization follow-up for application) Form and Instruction	Unchanged
207872	155.225(b)(1) (organization designation by Exchange) Form and Instruction	Unchanged

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CMS
OMB Control No	0938-1205
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202110-0938-014
Agency Tracking No	CCIIO - 10494
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31