Information Collection

Suppliers that Choose Not to Grandfather - Round 1 Recompete (10-Day and 2-Day Notifications)

IC 207247 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 Not to Grandfather - Round 1 Recompete (10-Day and 2-Day Notifications)	Form
CMS-10309 Grandfather Non-Election Letter R12017_Grandfathering_Sample_Non-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 Non-Election Letter	R12017_Grandfathering_Sample_Non-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: 102

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	9,996	8,348	1,648
Annual IC Time Burden (Hours)	4,998	4,174	824
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.