Monthly Data Reports

Payment Collections Operations Contingency Plan

OMB: 0938-1217

IC ID: 209728

Information Collection (IC) Details

View Information Collection (IC)

Monthly Data Reports
 
No New
 
Required to Obtain or Retain Benefits
 
45 CFR 156.430

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10515 Copy of Enrollment and Payment Data Template CMS-10515 - Copy of Enrollment and Payment Data Template 12 1 13v3.xlsx Yes Yes Fillable Fileable

Health Health Care Services

 

575 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   6 %

  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 3,450 3,450 0 0 0 0
Annual IC Time Burden (Hours) 41,400 41,400 0 0 0 0
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.

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