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In-Network Rate File
Transparency in Pricing Information (CMS-10715)
OMB: 0938-1429
IC ID: 249944
OMB.report
HHS/CMS
OMB 0938-1429
ICR 202410-0938-023
IC 249944
( )
Documents and Forms
Document Name
Document Type
Form CMS-10715
In-Network Rate File
Form and Instruction
CMS-10715 APPENDIX 2: In-network Rate Machine-Readable File Data E
CMS-10715 (Appendix 2) In-network Rate File Data Elements(clean)_10.07.24.docx
Form and Instruction
CMS-10715 APPENDIX 3: The Allowed Amount Machine-Readable File Dat
CMS-10715 (Appendix 3) Allowed Amount Machine-Readable File(clean)_10.07.24.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
In-Network Rate File
Agency IC Tracking Number:
CCIIO - 10715
Is this a Common Form?
Yes
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
45 CFR 147.212(b)(1)(i)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10715
APPENDIX 2: In-network Rate Machine-Readable File Data Elements
CMS-10715 (Appendix 2) In-network Rate File Data Elements(clean)_10.07.24.docx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10715
APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
CMS-10715 (Appendix 3) Allowed Amount Machine-Readable File(clean)_10.07.24.docx
Yes
Yes
Fillable Fileable
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:
836
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:
100 %
Requested
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
10,032
0
0
1,869
0
8,163
Annual IC Time Burden (Hours)
310,992
0
0
-2,822,102
0
3,133,094
Annual IC Cost Burden (Dollars)
0
0
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.