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Information Collection

Monthly Data Submission Accuracy Certification Form

IC 209729 under ICR 202508-0938-018 · OMB 0938-1217.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Monthly Data Submission Accuracy Certification Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10515 Monthly Data Submission Accuracy Certification Form CMS-10515 - Certification.xlsx Yes Yes Fillable Fileable

Health Health Care Services

 

25 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 150 0 0 -150 300 0
Annual IC Time Burden (Hours) 25 0 0 -26 51 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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