Information Collection Request

Electronic Submission of Medicare GME Affiliation Agreements

ICR 201006-0938-013 · OMB 0938-1111 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Electronic Submission to CMS Form and Instruction New Available
Form 1 Hardcopy Submission to FI or MAC Form and Instruction New Available
Form 1 Development of Agreement Form and Instruction New Available
CMS-10326.Supporting Statement Part A (8-13-10).doc Supporting Statement A Uploaded 2010-08-13 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
193422 Electronic Submission to CMS Form and Instruction New
193421 Hardcopy Submission to FI or MAC Form and Instruction New
193420 Development of Agreement Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
0 0 0
0 0 0
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Development of Agreement 1 Sample Affiliation Agreement
Hardcopy Submission to FI or MAC 1 Sample Affiliation Agreement
Electronic Submission to CMS 1 Sample Affiliation Agreement



Reginfo record details
  No