OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Collection of Dental Provider Information

IC 189778 under ICR 202404-0938-021 · OMB 0938-1065.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Collection of Dental Provider Information
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10291 IKN Dental Provider Data Submission Technical Information InsureKidsNowTechGuidanceV312.pdf Yes Yes Fillable Printable

Health Health Care Services

 

51 0
   
State, Local, and Tribal Governments
 
   100 %

  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 204 0 0 0 0 204
Annual IC Time Burden (Hours) 10,506 0 0 0 0 10,506
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
REDLINE - Insure Kids Now Provider Data Submission Technical Information REDLINE - InsureKidsNowTechGuidanceV312.docx 04/25/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.