Miscellaneous Tasks: Applicant Follows-Up, Applicant Gives Further Clarification of Data or Gives Further Application Information to CMS

PRA for the Add-On Payments for New Medical Services and Technologies Policy

OMB: 0938-1347

IC ID: 227314

Information Collection (IC) Details

View Information Collection (IC)

Miscellaneous Tasks: Applicant Follows-Up, Applicant Gives Further Clarification of Data or Gives Further Application Information to CMS
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction FY_2018_New_Technology_Cost_Spreadsheet Example.xlsx Yes No Printable Only
Form CMS-10638 New Technology Tracking Form FY_2018_New_Technology_Tracking_Form.docx Yes Yes Fillable Printable
Form CMS-10638 New Technology Application CMS-10638.PRA request FY_2019_New_Technology_Application-revised.docx Yes Yes Fillable Fileable

Health Health Care Services

 

15 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 15 0 15 0 0 0
Annual IC Time Burden (Hours) 600 0 600 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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