OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Quarterly and Monthly Reporting

IC 193921 under ICR 201308-0938-003 · OMB 0938-1100.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Quarterly and Monthly Reporting
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10339 State Solicitation CMS-10339.state_solicitation.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10339 Contract Template CMS-10339.HHS Template Contract.docx Yes Yes Fillable Fileable

Health Health Care Services

 

51 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 612 0 0 0 0 612
Annual IC Time Burden (Hours) 14,688 0 0 0 0 14,688
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.