OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Respond to the final distributed data report

IC 254457 under ICR 202412-0938-011 · OMB 0938-1155.

Documents and Forms
Document Name
Document Type
Other-Data Elements
Other-Data Elements
Information Collection (IC) Details

View Information Collection (IC)

Respond to the final distributed data report CCIIO
 
No Modified
 
Mandatory
 
45 CFR 153.710

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Data Elements CMS-10401 - Appendix A.docx No   Paper Only

Health Health Care Services

 

650 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  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 650 0 0 0 0 650
Annual IC Time Burden (Hours) 3,900 0 0 0 0 3,900
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.