Information Collection Request
Collection of Encounter Data from MA Organizations, Section 1876 Cost HMOs/CMPs, MMPs, and PACE Organizations (CMS-10340)
ICR 202403-0938-009 · OMB 0938-1152 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1152 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10340 Submitter Authorization Form |
Form | Modified | Repair queued |
| Form CMS-10340 Submitter Application and Instructions |
Form and Instruction | Modified | Repair queued |
| Form CMS-10340 Electronic Data Interchange (EDI) Agreement |
Form | Unchanged | Repair queued |
 10340 - Supporting Statement A_Encounter Data.docx |
Supporting Statement A | Uploaded 2024-03-28 | Repair queued |
| DENTAL PRA RESPONSE Final.docx |
Supplementary Document | Uploaded 2024-03-14 | Repair queued |
 CMS-10340 Dental PRA Crosswalk.pdf |
Supplementary Document | Uploaded 2024-03-28 | Repair queued |
| SSN Justification.pdf |
Supplementary Document | Uploaded 2017-08-29 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 247095 |  Complete Certification |
Unchanged | ||
| 246826 | Reviewing Encounter Data Submission Guidance |
Instruction | Modified | |
| 225029 | Connect: Direct Applications for RAPS, Encounter, PDE, and MMP |
Instruction | Modified | |
| 225027 | Submitter Authorization Form |
Form | Modified | |
| 225026 | Submitter Application and Instructions |
Form and Instruction | Modified | |
| 225025 | Electronic Data Interchange (EDI) Agreement |
Form | Unchanged | |
| 199936 | Encounter Data Submission |
Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1152 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202302-0938-015 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |