Information Collection

Improper Payment and Pre-Testing Assessment

IC 257715 under ICR 202301-0938-002 · OMB 0938-1439.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1439 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10829 Improper Payment and Pre-Testing Assessment Form and Instruction
CMS-10829 Data Request Form CMS-10829 - IPPTA_Data Request Form - Final.xlsx Form and Instruction
CMS-10829 Data Request Form CMS-10829 - IPPTA_Data Request Form - Final.xlsx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Improper Payment and Pre-Testing Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10829	Data Request Form	CMS-10829 - IPPTA_Data Request Form - Final.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	9,540	9,540
Annual IC Cost Burden (Dollars)	1,025,748	1,025,748

Documents for IC

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.