Generalized Claims Data Call Submission

Healthcare Fraud Prevention Partnership (HFPP): Data Sharing and Information Exchange

OMB: 0938-1251

IC ID: 226677

Information Collection (IC) Details

View Information Collection (IC)

Generalized Claims Data Call Submission
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10501 Data Submission Template Data Submission Template PRA Package 411.docx No   Fillable Printable
Instruction Instructions TTP Data Call Submission Process PRA Package 411.docx No   Paper Only

Health Health Care Services

 

20 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 240 0 240 0 0 0
Annual IC Time Burden (Hours) 80 0 80 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10501 - Generic Mini Supporting Statement CMS-10501 - Generic Mini Supporting Statement 6817.docx 06/08/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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