Information Collection

Simplified Methodology Effective Parameters and Plan and Policy Reports

IC 213320 under ICR 202012-0938-014 · OMB 0938-1266.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1266 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10526 Simplified Methodology Effective Parameters and Plan and Policy Reports Form and Instruction
CMS-10526 CSR Reconciliation Data Elements CMS-10526 CSR Recon PRA_Collection Elements revision (01 12 2016) clean.docx Form and Instruction
CMS-10526 CSR Reconciliation Data Elements CMS-10526 CSR Recon PRA_Collection Elements revision (01 12 2016) clean.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Simplified Methodology Effective Parameters and Plan and Policy Reports	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 156.430

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10526	CSR Reconciliation Data Elements	CMS-10526 CSR Recon PRA_Collection Elements revision (01 12 2016) clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 191	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-260,142	260,142
Annual IC Time Burden (Hours)	-3,819	3,819
Annual IC Cost Burden (Dollars)	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.