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Federal forms, ICRs, and supporting documents

Information Collection

#79 (New): COVID-19 Risk Corridor Reconciliation Reporting Template

IC 258773 under ICR 202401-0938-016 · OMB 0938-1148.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Other-Frequently Asked Questions (FA
Other-Frequently Asked Questions (FA
Other-CMCS Outreach Email
Other-CMCS Outreach Email
Other-Sample Section 1115 Approval L
Other-Sample Section 1115 Approval L
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

#79 (New): COVID-19 Risk Corridor Reconciliation Reporting Template CMCS
 
Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10398 #79 COVID-19 Risk Corridor Reconciliation Reporting Template COVID-19 Risk Corridor Reconciliation Reporting Template.xlsm Yes Yes Fillable Fileable
Other-Frequently Asked Questions (FAQs) COVID-19 Frequently Asked Questions (FAQs).pdf Yes No Printable Only
Other-CMCS Outreach Email CMCS Outreach Email_2023-01-10.docx Yes No Printable Only
Other-Sample Section 1115 Approval Letter HI Risk Mitigation Approval Letter 12202021.pdf Yes No Printable Only

Health Health Care Services

 

30 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 30 0 0 0 0 30
Annual IC Time Burden (Hours) 90 0 0 0 0 90
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement #79 - Generic Supporting Statement (2023 version 8).docx 02/25/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.