(Cycle II) Quarterly Report

Cycle I, II, and III - "Grants to Support States in Health Insurance Rate Review and Pricing Transparency" Reporting

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1121 can be found here:

Documents and Forms

Document Name Document Type
Form CMA-10380 (Cycle II) Quarterly Report Form and Instruction
CMA-10380 Cycle II FOA Cycle II Rate Review Grants FOA (2-24-11@1130am).docx Form and Instruction
CMS-10380 Cycle II - Quarterly Report Template Grant_Cycle_II_Quarterly_Report_Template-a.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	(Cycle II) Quarterly Report	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	CMA-10380	Cycle II FOA	Cycle II Rate Review Grants FOA (2-24-11@1130am).docx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10380	Cycle II - Quarterly Report Template	Grant_Cycle_II_Quarterly_Report_Template-a.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 34	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	224	224
Annual IC Time Burden (Hours)	5,376	5,376
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.