Submitter Application and Instructions

Collection of Risk Adjustment Data from MA Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 HCPPS, MMPS, and PACE Organizations (CMS-10340)

OMB: 0938-1152

IC ID: 225026

Information Collection (IC) Details

View Information Collection (IC)

Submitter Application and Instructions
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10340 CSSC Operations Submitter Application (Form and Instruction) 12_2_2 Submitter Application with OMB [rev OSORA PRA].docx Yes Yes Fillable Fileable

Health Health Care Services

 

691 0
   
Private Sector 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 691 0 0 691 0 0
Annual IC Time Burden (Hours) 57 0 0 57 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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