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CMS-10440 Application for Health Coverage & Help Paying Costs
Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and CHIP Agencies (CMS-10440)
Att-C marketplace-consumer-application-family-clean-508-2 2025
Individual Application
OMB: 0938-1191
OMB.report
HHS/CMS
OMB 0938-1191
ICR 202504-0938-017
IC 205692
CMS-10440 Application for Health Coverage & Help Paying Costs
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1191 can be found here:
2025-07-09 - Revision of a currently approved collection
2025-06-04 - Revision of a currently approved collection
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