Information Collection

TPAs

IC 250682 under ICR 202112-1210-001CF · OMB 0938-1407.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1407 can be found here:

Documents and Forms

Document Name Document Type
CMS-10788.RxDC Section 204 Reporting Instructions 11-23-21 (final).docx Instruction

Information Collection (IC) Details

View RCF Information Collection (IC)

IC Title:	TPAs	Agency IC Tracking Number:	CCIIO - 10788

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 149.730 45 CFR 149.720 45 CFR 149.740

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10788.RxDC Section 204 Reporting Instructions 11-23-21 (final).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	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 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	23	23
Annual IC Time Burden (Hours)	104,243	104,243
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.