Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)

ICR 202302-0938-001

OMB: 0938-1285

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers) Form and Instruction	Modified
Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer) Form and Instruction	Modified
Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs) Form and Instruction	Modified
CMS-10492 - User Fee Adjustment Supporting Statement - 2223.docx Supporting Statement A	2023-02-02

IC Document Collections

IC ID	Document Title	Status
258236	Data Submission and Maintenance of Records for Individual Contraceptive Arrangement	New
258183	Collection of User Fee Adjustment Information from FFE (or SBE-FP) Participating Issuers Instruction	New
217425	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers) Form and Instruction	Modified
217424	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer) Form and Instruction	Modified
217422	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs) Form and Instruction	Modified