Information Collection Request
Disclosure of State Rating Requirements Notice (CMS-10454)
ICR 202405-0938-023 · OMB 0938-1258 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10454 Disclosure of State Rating Requirements |
Form and Instruction | Modified | Repair queued |
 CMS-10454 Supporting Statement - 05-16-2024 Clean.docx |
Supporting Statement A | Uploaded 2024-05-21 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 208568 |  Disclosure of State Rating Requirements |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1258 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202212-0938-001 |
| Agency Tracking No | CCIIO - 10454 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |