Information Collection Request

Information Collection Requirements Contained in the State Flexibility to Stabilize the Market Grant Program (CMS-10657)

ICR 202112-0938-016 · OMB 0938-1366 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10657 State Flexibility Grants Activities Form and Instruction Modified Repair queued
CMS-10657 - Supporting Statement 30 day PRA input Final (OMB).docx Supporting Statement A Uploaded 2022-01-07 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
235550 State Flexibility Grants Activities Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 07/31/2022
170 155
2,312 2,108
0 0





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table that charts list of burden
IC Title Form No. Form Name
State Flexibility Grants Activities CMS-10657, CMS-10657, CMS-10657 State Flexibility Grant Annual Report Template ,   State Flexibility Grant Quarterly Report Template ,   State Flexibility Grant Final Report Template

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 170 155 0 0 15 0
Annual Time Burden (Hours) 2,312 2,108 0 0 204 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No