Information Collection

Regional PPO Risk-Sharing Reconciliation Cost Report

IC 181538 under ICR 200708-0938-005 · OMB 0938-1032.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.