Information Collection

Grandfathering

IC 244401 under ICR 202011-0938-001 · OMB 0938-1408.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10744.Grandfathering_Sample_Election_Letter.pdf	Instruction
CMS-10744.Sample Letter - Chooses NOT to Grandfather.pdf	Instruction

IC Title:

Grandfathering

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

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
Instruction			CMS-10744.Grandfathering_Sample_Election_Letter.pdf		Yes	No	Fillable Fileable
Instruction			CMS-10744.Sample Letter - Chooses NOT to Grandfather.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,106

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	270,000	270,000
Annual IC Time Burden (Hours)	31,606	31,606
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.