Information Collection

Help desk forms

IC 280105 under ICR 202604-0938-023 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10945 Reconsideration Request Collection of Information Help desk forms	Form and Instruction
Form CMS-10945 Request for an Extraordinary Circumstances Extension/Exception (ECE) Collection of Information Help desk forms	Form and Instruction
CMS-10945 Reconsideration Request Collection of Information CMS-10945 PAC-QRP-Help-Desk-Req for Recon-Form-v0.3_508c.pdf	Form and Instruction
CMS-10945 Request for an Extraordinary Circumstances Extension/Exc CMS-10945 PAC-QRP-Help-Desk-ECE-Form-v08_508c.pdf	Form and Instruction

IC Title:

Help desk forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10945				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10945				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 33,340

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: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	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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