Improper Payment and Pre-Testing Assessment

Improper Payment Pre-Testing and Assessment (IPPTA) (CMS-10829)

Documents and Forms

Document Name Document Type
Form CMS-10829 Improper Payment and Pre-Testing Assessment Form and Instruction
CMS-10829 Data Request Form CMS-10829 - IPPTA_Data Request Form.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	Improper Payment and Pre-Testing Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10829	Data Request Form	CMS-10829 - IPPTA_Data Request Form.xlsx		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 %

	Requested	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

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.