Information Collection

Managed Care Plans' and their Subcontractors: Identify Costs and Report

IC 260421 under ICR 202601-0938-006 · OMB 0938-1445.

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Information Collection (IC) Details

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IC Title:	Managed Care Plans' and their Subcontractors: Identify Costs and Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 438.8(e)(2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 564	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 99 %

	Requested	Previously Approved
Annual Number of Responses for this IC	564	564
Annual IC Time Burden (Hours)	7,614	7,614
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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