Information Collection

Improper Payment and Pre-Testing Assessment

IC 257715 under ICR 202411-0938-006 · OMB 0938-1439.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10829 Improper Payment and Pre-Testing Assessment	Form and Instruction
Form CMS-10829 Data Request Form Improper Payment and Pre-Testing Assessment	Form and Instruction
CMS-10829 Data Request Form CMS-10829 - IPPTA_Data Request Form.xlsx	Form and Instruction
CMS-10829 Data Request Form CMS-10829 - IPPTA_Data Request Form.xlsx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10829				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11	-7	18
Annual IC Time Burden (Hours)	5,830	-3,710	9,540
Annual IC Cost Burden (Dollars)	0	-1,025,748	1,025,748

Documents for IC

table that charts IC Documents
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.

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