In-Network Rate File

Transparency in Pricing Information (CMS-10715)

Documents and Forms

Document Name Document Type
Form CMS-10317 In-Network Rate File Form and Instruction
CMS-10317 Appendix 2 - In-Network Rate Data Template CMS-10715-Transparency in Coverage_Appendix 2_Final .pdf Form and Instruction
CMS-10317 Appendix 2 - In-Network Rate Data Template CMS-10715-Transparency in Coverage_Appendix 2_Final .pdf Form and Instruction

Information Collection (IC) Details

IC Title:	In-Network Rate File	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 147.210(c)(1)(i)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10317	Appendix 2 - In-Network Rate Data Template	CMS-10715-Transparency in Coverage_Appendix 2_Final .pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 980	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	8,163	8,163
Annual IC Time Burden (Hours)	3,133,094	3,133,094
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.