Information Collection

Rate Review Grant - Cycle IV Annual Report

IC 212861 under ICR 201802-0938-006 · OMB 0938-1121.

Documents and Forms

Document Name Document Type
Form CMS-10380 Rate Review Grant - Cycle IV Annual Report Form and Instruction
CMS-10380 Rate Review Grant cycle IV - Annual Report CMS-10380_Grant_Cycle_IV_Annual_Report_Template.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rate Review Grant - Cycle IV Annual Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10380	Rate Review Grant cycle IV - Annual Report	CMS-10380_Grant_Cycle_IV_Annual_Report_Template.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	18	-24	42
Annual IC Time Burden (Hours)	1,680	0	1,680
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.