Information Collection

In-Network Rate File

IC 252393 under ICR 202203-0938-010 · OMB 0938-1423.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.