Regional PPO Risk-Sharing Reconciliation Cost Report

Documents and Forms

Document Name Document Type
Form CMS-10233 Regional PPO Risk-Sharing Reconciliation Cost Report Form
CMS-10233.RPPO Risk-Sharing Reconciliation Instructions.DOC Instruction
CMS-10233 Regional PPO Risk-Sharing Reconciliation Cost Report CMS-10233.RPPO Risk Sharing Reconciliation- 5-21-07.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Regional PPO Risk-Sharing Reconciliation Cost Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.458

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10233	Regional PPO Risk-Sharing Reconciliation Cost Report	CMS-10233.RPPO Risk Sharing Reconciliation- 5-21-07.xls		Yes	Yes	Fillable Fileable
Instruction			CMS-10233.RPPO Risk-Sharing Reconciliation Instructions.DOC		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	14	14
Annual IC Time Burden (Hours)	1,120	1,120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.