Information Collection

Suppliers that Choose to Grandfather - Round 1 Recompete (30-Day Notification to Beneficiary)

IC 207244 under ICR 201608-0938-007 · OMB 0938-1079.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10309 Suppliers that Choose to Grandfather - Round 1 Recompete (30-Day Notification to Beneficiary)	Form
CMS-10309 Grandfather Election Letter R12017_Grandfathering_Sample_Election_Letter.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.408(j)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10309	Grandfather Election Letter	R12017_Grandfathering_Sample_Election_Letter.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 921

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	90,258	75,423	14,835
Annual IC Time Burden (Hours)	7,752	6,434	1,318
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.