Information Collection

Rural Health Transformation (RHT) Program Reporting

IC 281344 under ICR 202607-0938-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10949 RHT Program Reporting Template Rural Health Transformation (RHT) Program Reporting	Form and Instruction
Form CMS-10949 RHT Program Project Plan Template Rural Health Transformation (RHT) Program Reporting	Form and Instruction
RHTP_State Reporting Expectations_Guide V7_6.12.26.docx	Instruction
PRA Resubmission Obligated and Spent Funds Reporting Guide 06.12.2026 v2.docx	Instruction
RHTP Draft Screens 06.09.2026.pdf	Other-Screen Shots
CMS-10949 RHT Program Reporting Template PRA Resubmission Reporting Template_06.12.26.xlsx	Form and Instruction
CMS-10949 RHT Program Project Plan Template PRA Project Plan Template.xlsx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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-10949	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10949	Yes	Yes	Fillable Fileable
Instruction		Yes	No	Printable Only
Instruction		Yes	No	Printable Only
Other-Screen Shots		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	20,000	20,000
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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