Federal Funding of Emergency Health Services (Sec. 1011): Enrollment Application

Federal Funding of Emergency Health Services (Sec. 1011): Enrollment Application

OMB: 0938-0929

IC ID: 8776

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Federal Funding of Emergency Health Services (Sec. 1011): Enrollment Application
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10115 Yes Yes


    

62,500 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5 0 5 0 0 0
Annual IC Time Burden (Hours) 31,250 0 31,250 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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