Information Collection

GenIC #62 (New): Data Collection for Section 1003 of the SUPPORT Act

IC 241052 under ICR 201712-0938-019 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Document Name Document Type
62 - Sec1003QtrlyInstructions (2020 version 5) Final.docx Instruction
CMS-10398 #62 Quarterly Progress Report (QPR) Template 62 - Sec1003QtrlyReportForm20200221-4.xlsx Form
62 - Generic Supporting Statement (2020 version 4).docx Generic Supporting Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	GenIC #62 (New): Data Collection for Section 1003 of the SUPPORT Act	Agency IC Tracking Number:	CMCS

IC Status: New

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
Instruction			62 - Sec1003QtrlyInstructions (2020 version 5) Final.docx		No		Printable Only
Form	CMS-10398 #62	Quarterly Progress Report (QPR) Template	62 - Sec1003QtrlyReportForm20200221-4.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Supporting Statement	62 - Generic Supporting Statement (2020 version 4).docx	04/03/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.