Information Collection

Issuer - Attest (Small Group)

IC 199284 under ICR 202510-0938-001 · OMB 0938-1086.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10320 CMS-10320 - Issuer - FINAL Instructions and Instruments Issuer - Attest (Small Group)	Form and Instruction
CMS 10320 Appendix C Issuer and Product Level Data_PRA 2020.pdf	Instruction
CMS 10320 Appendix D_Data Collection_PRA2020.pdf	Instruction
CMS-10320 CMS-10320 - Issuer - FINAL Instructions and Instruments CMS-10320 Issuer - FINAL Instructions and Instruments.pdf	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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10320	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Paper Only
Instruction		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	150	-350	500
Annual IC Time Burden (Hours)	75	-175	250
Annual IC Cost Burden (Dollars)	0	0	0

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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