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DUA and non-public analyses agreement Development
QECP Annual Report Workbook Submission Requirement for Qualified Entities under ACA Section 10332 (CMS-10589)
OMB: 0938-1309
IC ID: 220185
OMB.report
HHS/CMS
OMB 0938-1309
ICR 201608-0938-004
IC 220185
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1309 can be found here:
2021-01-11 - Reinstatement without change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
DUA and non-public analyses agreement Development
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR 401.718
42 CFR 401.716
42 CFR 401.713
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
15
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
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
15
15
0
0
0
0
Annual IC Time Burden (Hours)
300
300
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.