Information Collection Request

Rate Increase Disclosure and Review Reporting Requirements (CMS-10379)

ICR 202609-0938-015 · OMB 0938-1141 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-10379 - Supporting Statement 30-dayf .docx Supporting Statement A Uploaded 2026-11-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
198022 State Unreasonable Rate Increase Determinations Modified
198020 Submission of Unified Rate Review Templates (URRTs) Modified
198019 CSR - Load Factor Using the Standard Methodology - Implement - Update - Run Other-Microsoft Word Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 11/30/2027
1,004 1,211
6,258,823 17,756
0 0





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3
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IC Title Form No. Form Name
CSR - Load Factor Using the Standard Methodology - Implement - Update - Run
State Unreasonable Rate Increase Determinations
Submission of Unified Rate Review Templates (URRTs)

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,004 1,211 0 0 -207 0
Annual Time Burden (Hours) 6,258,823 17,756 0 0 6,241,067 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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  No