Reporting

QECP Annual Report Workbook Submission Requirement for Qualified Entities under ACA Section 10332 (CMS-10589)

OMB: 0938-1309

IC ID: 220190

Documents and Forms
Information Collection (IC) Details

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Reporting
 
No Modified
 
Voluntary
 
42 CFR 401.719(b)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10589 QECP Annual Report Workbook CMS-10589.QECP_2015_Annual_Report_Workbook - FINAL (1-9-17).xlsx Yes Yes Fillable Fileable Signable

Health Health Care Services

 

15 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  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) 750 750 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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