Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and CHIP Agencies (CMS-10440)

ICR 202504-0938-017

OMB: 0938-1191

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10440 Individual Application Form and Instruction	Modified
CMS-10440.Non-substantive change memo EOs 031425.docx Supplementary Document	2025-04-18
CMS-10440.Non-substantive change memo .docx Justification for No Material/Nonsubstantive Change	2024-09-27
CMS-10440.Non-sub change Screenshot.docx Supplementary Document	2024-09-27
CMS-10440 - Response to 60-day Comments.docx Supplementary Document	2024-07-15
OMB 0938-1191 CMS-10440 Supporting Statement - Clean 031425 .docx Supporting Statement A	2025-04-18

IC Document Collections

IC ID	Document Title	Status
205692	Individual Application Form and Instruction	Modified