Monthly Data Submission Accuracy Certification Form

Payment Collections Operations Contingency Plan (CMS-10515)

OMB: 0938-1217

IC ID: 209729

Information Collection (IC) Details

View Information Collection (IC)

Monthly Data Submission Accuracy Certification Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10515 Monthly Data Submission Accuracy Certification Form CMS-10515_Certification Tab_update_508.xlsx Yes Yes Fillable Fileable

Health Health Care Services

 

50 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 300 0 -600 0 900 0
Annual IC Time Burden (Hours) 51 0 -102 0 153 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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