Information Collection

Reporting Templates

IC 224908 under ICR 201612-0938-018 · OMB 0938-1320.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10605 Reporting Templates	Form and Instruction
CMS-10605 Annual Report Template CMS-10605 - The Enforcement and Consumer Protections Cycle I Annual Report Template ....pdf	Form and Instruction
CMS-10605 Quarterly Report Template CMS-10605 - The Enforcement and Consumer Protections Cycle I Quarterly Report Templa....pdf	Form and Instruction
CMS-10605 Final Report CMS-10605 - The Enforcement and Consumer Protections Cycle I Final Report Template ....pdf	Form and Instruction

IC Title:

Reporting Templates

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10605	Annual Report Template	CMS-10605 - The Enforcement and Consumer Protections Cycle I Annual Report Template ....pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-10605	Quarterly Report Template	CMS-10605 - The Enforcement and Consumer Protections Cycle I Quarterly Report Templa....pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10605	Final Report	CMS-10605 - The Enforcement and Consumer Protections Cycle I Final Report Template ....pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	115	115
Annual IC Time Burden (Hours)	2,898	2,898
Annual IC Cost Burden (Dollars)	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.