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#74 (New): Coverage of Routine Patient Cost for Items & Services in Qualifying Clinical Trials

IC 251149 under ICR 202401-0938-016 · OMB 0938-1148.

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Information Collection (IC) Details

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#74 (New): Coverage of Routine Patient Cost for Items & Services in Qualifying Clinical Trials CMCS
 
Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10398 #74 Att. 3.1-A (Qualifying Clinical Trial Draft Preprint) Preprint Att. 3.1-A (2022 version 3).docx Yes Yes Fillable Fileable
Form CMS-10398 #74 Att. 3.1.-B (Qualifying Clinical Trial Draft Preprint) Preprint Att. 3.1-B (2022 version 3).docx Yes Yes Fillable Fileable
Form and Instruction N/A Qualifying Clinical Trial Attestation Form 74 - QUALIFYING CLINICAL TRIAL ATTESTATION FORM CLEAN 8.17.21 I.pdf Yes Yes Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 66 0 0 0 0 66
Annual IC Time Burden (Hours) 61 0 0 0 0 61
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 74 - Generic Supporting Statement (2022 version 5).docx 01/24/2022
Public Comment 84f2c322 - GenIC #74 Comment.pdf 01/24/2022
Response to Public Comment Public Comments Received on GenIC #74.docx 01/24/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.