Information Collection Request

Reporting Requirements for Grants to States for Rate Review Cycle IV and Effective Rate Review Program (CMS-10380)

ICR 201802-0938-006 · OMB 0938-1121 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10380 Transaction Data Collection Form Modified Available
Form CMS-10380 Rate Review Grant - Cycle IV Annual Report Form and Instruction Modified Available
Form CMS-10380 Rate Review Program Grant - Quarterly Report Form and Instruction Modified Available
CMS-10380 Supporting Statement 30-day Final.docx Supporting Statement A Uploaded 2019-07-18 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
212866 Rate Review Program Grant - Cycle IV Application Removed
212865 Effective Rate Review Program Modified
212864 Transaction Data Collection Form Modified
212863 Rate Review Program Grant - Cycle IV Final Report Modified
212861 Rate Review Grant - Cycle IV Annual Report Form and Instruction Modified
212860 Rate Review Program Grant - Quarterly Report Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2022 36 Months From Approved
249 0 0
14,405 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 249 0 0 2 -306 553
Annual Time Burden (Hours) 14,405 0 0 210 -6,756 20,951
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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