OMB control number

Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges (CMS-10371)

OMB 0938-1119 · HHS/CMS.

OMB 0938-1119

Information collected as a part of the application for this grant will be used to evaluate the applications and determine awardees. Information collected pursuant to the reporting requirements for awardees will be used to evaluate the progress of States in planning for and implementing Exchanges, and determine how the Secretary can provide assistance to achieve the goals of the grant program and the Affordable Care Act.

The latest form for Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges (CMS-10371) expires 2028-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10371 SBM Three-year Budget Reports Form and Instruction
Form CMS-10371 SBM Individual Market Reports (weekly) Form and Instruction
CMS-10371 - Bi-Annual Metric.pdf Supplementary Document
CMS-10371 - SBM Metrics.pdf Supplementary Document
CMS-10371SBEBudgetTemplate.xls Supplementary Document
CMS-10371 - APPENDIX A.pdf Supplementary Document
CMS-10371 - Supporting Statement.docx Supporting Statement A
State Based Marketplace Data Collection Templates for Bi-Annual Reporting Other-Data Template
SBM Three-year Budget Reports Form and Instruction
SBM Individual Market Reports (weekly) Form and Instruction
End of Enrollment Budget Report Other-Data Elements

All Historical Document Collections

202506-0938-001	Reinstatement without change of a previously approved collection	2025-06-04
202404-0938-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-04-11
202302-0938-016 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-03-10
202203-0938-011 Approved without change	Reinstatement with change of a previously approved collection	2022-04-12
201708-0938-014 Approved without change	Revision of a currently approved collection	2017-08-31
201504-0938-011 Approved without change	Revision of a currently approved collection	2015-04-24
201411-0938-005 Approved without change	Revision of a currently approved collection	2014-11-10
201308-0938-024 Approved without change	Revision of a currently approved collection	2013-08-23
201203-0938-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-03-21
201111-0938-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-11-22
201107-0938-018 Approved with change	Revision of a currently approved collection	2011-07-29
201101-0938-006 Approved with change	New collection (Request for a new OMB Control Number)	2011-01-18

OMB Details

End of Enrollment Budget Report

Federal Enterprise Architecture: Health - Health Care Services