Information Collection Request

QECP Annual Report Workbook Submission Requirement for Qualified Entities under ACA Section 10332 (CMS-10589)

ICR 202101-0938-004 · OMB 0938-1309 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10589 Reporting Form and Instruction Modified Repair queued
CMS-10589 -Supporting Statement Part A.docx Supporting Statement A Uploaded 2021-01-08 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
220190 Reporting Form and Instruction Modified
220188 Processing and Maintenance Unchanged
220186 Legal Review Unchanged
220185 DUA and non-public analyses agreement Development Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
1,095 0
3,450 0
0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Reporting CMS-10589 QECP Annual Report Workbook
DUA and non-public analyses agreement Development
Legal Review
Processing and Maintenance

table that charts list of burden
  Total Request 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 1,095 0 0 0 0 1,095
Annual Time Burden (Hours) 3,450 0 0 0 0 3,450
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No