Information Collection

State Plan preprints to Implement Sections of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-emergencies

IC 180500 under ICR 200910-0938-013 · OMB 0938-0993.

Documents and Forms

Document Name Document Type
Form CMS-10190 State Plan preprints to Implement Sections of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-emergencies Form and Instruction
CMS-10190 6043 Costsharing Preprint PRA 508ed_DRA Preprint 6043CostsharingPreprint revised Att 4 18-H clean (2).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Plan preprints to Implement Sections of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-emergencies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10190	6043 Costsharing Preprint	PRA 508ed_DRA Preprint 6043CostsharingPreprint revised Att 4 18-H clean (2).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	667	667
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.