Information Collection

(Cycle III) Transaction Data Collection

IC 208092 under ICR 201308-0938-004 · OMB 0938-1121.

⚠️ Notice: This information collection may be referencing outdated material.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 CMS-10380 (Cycle III) Transaction Data Collection Form and Instruction
CMS-10380 Cycle III - Data CMS-10380 - Rate Review Grant Program Data Dictionary_0713.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	(Cycle III) Transaction Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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-10380	Cycle III - Data	CMS-10380 - Rate Review Grant Program Data Dictionary_0713.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	280	280
Annual IC Time Burden (Hours)	8,400	8,400
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.