CMS-10494 Training Completion Document

Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to
a collection of information unless it displays a valid Office of Management and Budget (OMB) control number. The valid OMB
control number for this information collection is 0938-1205 (Expiration Date XX,XX,XXXX). The time required to complete this
information collection is estimated to average .08 hours per response, including the time to review instructions, to make IT
changes to collect, consolidate and report the required information, in the required format, to HHS. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security
Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.