AM and Applicable GPO (Assumptions Document)

Registration, Attestation, Assumptions Document and Data Retention Requirements for Open Payments

OMB: 0938-1237

IC ID: 211456

Information Collection (IC) Details

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AM and Applicable GPO (Assumptions Document)
 
No New
 
Mandatory
 
42 CFR 403.908(f)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10495 Assumptions Assumptions Submission screen shots (starting on page 6).docx Yes Yes Fillable Printable

Health Health Care Services

 

1,570 0
   
Private Sector Businesses or other for-profits
 
   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 1,570 1,570 0 0 0 0
Annual IC Time Burden (Hours) 1,570 1,570 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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