Information Collection Request

Administrative Requirements for Section 6071 of the Deficit Reduction Act of 2005 (CMS-10249)

ICR 200810-0938-007 · OMB 0938-1053 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10249 Administrative Requirements for Section 6071 of the DRA (CMS-10249) Form and Instruction New Available
CMS-10249 Supporting Statement.doc Supporting Statement A Uploaded 2008-09-19 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
186838 Administrative Requirements for Section 6071 of the DRA (CMS-10249) Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2011 36 Months From Approved
304 0 0
10,394 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Administrative Requirements for Section 6071 of the DRA (CMS-10249) CMS-10249, CMS-10249, CMS-10249, CMS-10249, CMS-10249 Operational Protocol ,   Budget Form ,   MFP Demonstration Financial Form ,   Medical Assistance Expenditures by Type of Service ,   6352 MFP Questionnaire

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 304 0 0 304 0 0
Annual Time Burden (Hours) 10,394 0 0 10,394 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No