Information Collection

Reinstatement of Prior Burden Estimates for CMS-10184E

IC 193769 under ICR 201007-0938-002 · OMB 0938-1012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10184.FINAL-PE Reinstatement of Prior Burden Estimates for CMS-10184E	Form
CMS-10184.PERM_Form_Instructions-10-30-06.DOC	Instruction
CMS-10184.FINAL-PE CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms-10-30-06.doc	Form

IC Title:

Reinstatement of Prior Burden Estimates for CMS-10184E

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

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-10184.FINAL-PERM_Eligibility_Error_Rate_Forms	CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms	CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms-10-30-06.doc		Yes	Yes	Fillable Fileable
Instruction			CMS-10184.PERM_Form_Instructions-10-30-06.DOC		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	204	204
Annual IC Time Burden (Hours)	20,400	20,400
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.