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Federal forms, ICRs, and supporting documents

Information Collection

GenIC #7 (Revised): Cycle Vb (Final Report Template for the Round III AI/AN Cooperative Agreements), Cycle Va (Semi-Annual Template), and Cycle Vb (Monthly and Final Report Templates)

IC 236649 under ICR 201712-0938-019 · OMB 0938-1148.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form CMS-10398 #7
HEALTHY KIDS Cycle Va: Semi-Annual Report Template (qualitative report) GenIC #7 (Revised): Cycle Vb (Final Report Template for the Round III AI/AN Cooperative Agreements), Cycle Va (Semi-Annual Template), and Cycle Vb (Monthly and Final Report Templates)		 Form
Form CMS-10398 #7
HEALTHY KIDS Cycle Vb: Final Report Template (qualitative report) GenIC #7 (Revised): Cycle Vb (Final Report Template for the Round III AI/AN Cooperative Agreements), Cycle Va (Semi-Annual Template), and Cycle Vb (Monthly and Final Report Templates)		 Form
Form CMS-10398 #7
MACRA Cycle Vb, Round III: Final Report Template GenIC #7 (Revised): Cycle Vb (Final Report Template for the Round III AI/AN Cooperative Agreements), Cycle Va (Semi-Annual Template), and Cycle Vb (Monthly and Final Report Templates)		 Form
Form CMS-10398 #7
HEALTHY KIDS Cycle Vb: Monthly Report Targets vs Other (quantitative reporting) GenIC #7 (Revised): Cycle Vb (Final Report Template for the Round III AI/AN Cooperative Agreements), Cycle Va (Semi-Annual Template), and Cycle Vb (Monthly and Final Report Templates)		 Form
Form CMS-10398 #7
HEALTHY KIDS Cycle Vb: Monthly Report (quantitative reporting) GenIC #7 (Revised): Cycle Vb (Final Report Template for the Round III AI/AN Cooperative Agreements), Cycle Va (Semi-Annual Template), and Cycle Vb (Monthly and Final Report Templates)		 Form
CMS-10398 #7 HEALTHY KIDS Cycle Va: Semi-Annual Report Template (qual
HEALTHY KIDS Cycle Va SAR Template with PRA Disclosure.docx 		Form
CMS-10398 #7 HEALTHY KIDS Cycle Vb: Final Report Template (qualitativ
HEALTHY KIDS Cycle Vb Final SAR Template with PRA Disclosure.docx 		Form
CMS-10398 #7 MACRA Cycle Vb, Round III: Final Report Template
MACRA Cycle Vb Round III Final Report Template.docx 		Form
CMS-10398 #7 HEALTHY KIDS Cycle Vb: Monthly Report Targets vs Other (
Monthly report - targets vs other v9_1.11.19.xlsm 		Form
CMS-10398 #7 HEALTHY KIDS Cycle Vb: Monthly Report (quantitative repo
Monthly report v41_1.11.19.xlsm 		Form
Crosswalk.xlsx
Crosswalk		IC Document
GenIC 7 - Supporting Statement (2019 version 5).docx
GenIC Supporting Statement		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-10398 #7 Yes Yes Fillable Fileable
Form CMS-10398 #7 Yes Yes Fillable Fileable
Form CMS-10398 #7 Yes Yes Fillable Fileable
Form CMS-10398 #7 Yes Yes Fillable Fileable
Form CMS-10398 #7 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 1,634 0 1,634 0 0 0
Annual IC Time Burden (Hours) 5,258 0 5,258 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Crosswalk 08/16/2019
GenIC Supporting Statement 08/16/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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