OMB control number
Supporting Statement for Direct Enrollment Entities (CMS-10877)
OMB 0938-1463 · HHS/CMS.
This Information Collection Request (ICR) serves as the formal request for a new clearance associated with the Department of Health and Human Services (HHS) Program Integrity: Exchange, SHOP, and Eligibility Appeals Final Rule; and Notice of Benefit and Payment Parameters for 2018 Final Rule (2018 Payment Notice), 2020 Final Rule (2020 Payment Notice), 2022 Final Rule (2022 Payment Notice), 2023 Final Rule (2023 Payment Notice), and the 2025 Proposed Rule (2025 Payment Notice). This ICR details the burden associated with direct enrollment (DE) requirements that affect DE Entities (i.e., web-brokers and QHP issuers) as finalized in the 2020 Payment Notice covered under regulations in 45 C.F.R. §§ 155.205, 155.220, 155.221, and 156.1230; agreements between the Centers for Medicare & Medicaid Services (CMS) and DE Entities; and applicable program guidance issued by CMS; and 2022 and 2023 Payment Notices at 45 C.F.R. §§155.220 and 155.221. These DE requirements relate to Web-broker Operational Readiness Reviews (ORR); DE Entity ORR; Web-broker display of QHP comparative information and disclaimer; Web-broker rationale for QHP recommendations and methodology of QHP display; and required Disclaimers.
The latest form for Supporting Statement for Direct Enrollment Entities (CMS-10877) expires 2027-09-30 and can be found here.
Document Name |
|---|
Form and Instruction |
Form and Instruction |
Supplementary Document |
Supporting Statement A |
Form CMS-10877 DE Entity Operational Readiness Review (ORR)
CMS-10877 - Appendix_R_Direct_Enrollment_Entities_60-Day_Comment_Response_508.pdf
CMS-10877 Direct Enrollment Entities_Supporting Statementf.docx
Web-brokers to Prominently Display Consumer Eligibility Results for Advance Payments of the Premium Tax Credit and Cost-sharing Reductions |
Approved with change |
New collection (Request for a new OMB Control Number) | 2024-04-22 | |
|
Comment filed on proposed rule |
New collection (Request for a new OMB Control Number) | 2023-12-05 |
Web-broker Operational Readiness Reviews (ORR)
Federal Enterprise Architecture: Health - Health Care Services
| Form CMS-10877 | Security and Privacy Assessment Reports (SARs) template | Fillable Fileable | Form and instruction |
| Form CMS-10877 | Web-Broker Agreement | Fillable Fileable | Form and instruction |
| Form CMS-10877 | System Security and Privacy Plans (SSPs) workbook | Paper Only | Form and instruction |
| Form CMS-10877 | Plans of Action and Milestones (POA&Ms) template | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.