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Information Collection

155.225(b)(1) (organization follow-up for application)

IC 207873 under ICR 202210-0938-013 · OMB 0938-1205.

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Form and Instruction
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Information Collection (IC) Details

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155.225(b)(1) (organization follow-up for application)
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
45 CFR 155.225(b)(1)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10494 CAC Organization Application CMS-10494-Appendix A_CAC Online Application.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   80 %

  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 1,000 0 0 0 0 1,000
Annual IC Time Burden (Hours) 500 0 0 0 0 500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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