Information Collection Request
Reconciliation of State Invoice (ROSI) (CMS-304) and Prior Quarter Adjustment Statement (PQRS) (CMS-304a)
ICR 202403-0938-004 · OMB 0938-0676 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-304a Prior Quarter Adjustment Statement (PQAS) (CMS-304a) |
Form | Modified | Repair queued |
 CMS-304_304a - Supporting Statement A (2024 version 6).docx |
Supporting Statement A | Uploaded 2024-03-07 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8261 |  Reconciliation of State Invoice (ROSI) (CMS-304) |
Instruction | Modified | |
| 46422 | Prior Quarter Adjustment Statement (PQAS) (CMS-304a) |
Form | Modified | |
| 245951 | CMS-304 and CMS-304a – One-Time System Updates |
Removed |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0676 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202102-0938-015 |
| Agency Tracking No | CMCS |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |