OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Alternative Benefits State Plan Amendment HOA Demonstration Program (CMS-10216)

IC 46477 under ICR 200706-0938-006 · OMB 0938-1007.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
SMD011007.pdf Instruction
CMS-10216 HOA Pre-print Final
HOA_preprintfinal112906.pdf 		Form
US Code Title 26A1BVII.pdf
US Code Title 26A1BVII		IC Document
30-day FR.pdf
30-day FR notice		IC Document
AARP May 22, 2007 comment.tif
Comment		IC Document
Response to Comment from AARP.doc
Response to Comment from AARP		IC Document
60-day FR.pdf
60-day FR		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction SMD011007.pdf No No Paper Only
Form CMS-10216 HOA Pre-print Final HOA_preprintfinal112906.pdf No No Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 10 0 0 0 0 10
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
US Code Title 26A1BVII US Code Title 26A1BVII.pdf 06/15/2007
30-day FR notice 30-day FR.pdf 06/15/2007
Comment AARP May 22, 2007 comment.tif 06/15/2007
Response to Comment from AARP Response to Comment from AARP.doc 06/15/2007
60-day FR 60-day FR.pdf 06/15/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.