Information Collection Request

Essential Community Provider Data Collection to Support QHP Certification (CMS-10561)

ICR 202206-0938-008 · OMB 0938-1295 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-10561 ECP Petition Supporting Statement_10.28.21.docx Supporting Statement A Uploaded 2022-06-09 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
218061 Essential Community Provider Petition Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
12,408 0
9,420 0
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Essential Community Provider Petition

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 12,408 0 0 0 -2,550 14,958
Annual Time Burden (Hours) 9,420 0 0 0 -12,984 22,404
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No