Information Collection

Corrective Action Report

IC 46149 under ICR 201609-0938-031 · OMB 0938-1012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1012 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10184 Corrective Action Report Form
CMS-10184 Summary of Eligibility and Payment Review Findings CMS-10184.Summary of Eligibility and Payment Review Findings.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Corrective Action Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10184	Summary of Eligibility and Payment Review Findings	CMS-10184.Summary of Eligibility and Payment Review Findings.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 34	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	34	34
Annual IC Time Burden (Hours)	34,000	34,000
Annual IC Cost Burden (Dollars)	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.