OMB
.report
Search
Direct Enrollment Entities to Implement Third-Party Entity Contractual Requirements
Supporting Statement for Direct Enrollment Entities (CMS-10877)
OMB: 0938-1463
IC ID: 263471
OMB.report
HHS/CMS
OMB 0938-1463
ICR 202404-0938-015
IC 263471
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Direct Enrollment Entities to Implement Third-Party Entity Contractual Requirements
Agency IC Tracking Number:
CCIIO - 10877
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
45 CFR 155.221(g)(3), (4), and (7)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
25
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
25
25
0
0
0
0
Annual IC Time Burden (Hours)
500
500
0
0
0
0
Annual IC Cost Burden (Dollars)
37,500
37,500
0
0
0
0
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.