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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Early Retiree Reinsurance Program - Private Application
Removed
0
0
0
Form
CMS-10321
Deliberative Document
Instruction
Early Retiree Reinsurance Program - Public Application
Removed
0
0
0
Form
CMS-10321
Deliberative Document
Instruction
Early Retiree Reinsurance Program Appeals (Private), for Program Year 4
New
15
120
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Appeals (Private), for Program Years 2 and 3
New
100
800
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Appeals (Public), for Program Year 4
New
15
120
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Appeals (Public), for Program Years 2 and 3
New
100
800
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Reopening Requests (Private), for Program Years 2, 3, 4
New
10
80
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Reopening Requests (Pub lic), for Program Years 2, 3, 4
New
10
80
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Private) Program Year 2
New
3000
24000
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Private) Program Year 3
New
1200
105600
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Private) Program Year 4
New
30
2640
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Public) Program Year 2
New
3000
264000
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Public) Program Year 3
New
1200
105600
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Early Retiree Reinsurance Program Rerimburement Request Materials and Instructions (Cost Documentation) (Public) Program Year 4
New
30
2640
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Fraud and Abuse Procedures (Private) - Year 1
Removed
0
0
0
Fraud and Abuse Procedures (Public) - Year 1
Removed
0
0
0
Private Application Update Year 2_3_4
New
458
458
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Private CHOW Years 2_3_4
Modified
38
38
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Private Data Inaccuracies Years 2_3_4
Modified
20
1760
0
Instruction
Form
CMS-10321
ERRP Collection Instrument
Private Fraud and Abuse Procedures Years 2_3_4
Modified
764
15280
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Private Maintenance of Records Year 2_3_4
Modified
3055
18330
0
Instruction
Instruction
Private Written Agreement Year 2_3_4
Modified
764
764
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Public Application Update Year 2_3_4
New
458
458
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Public CHOW Years 2_3_4
Modified
2
2
0
Instruction
Form
CMS-10321
ERRP Collection Instrument
Public Data Inaccuracies Years 2_3_4
Modified
20
1760
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Public Fraud and Abuse Procedures Years 2_3_4
Modified
764
15280
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Public Maintenance of Records Year 2_3_4
Modified
3055
18330
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Public Written Agreement Year 2_3_4
Modified
764
764
0
Instruction
Form
CMS-10321
Revised ERRP Collection Instrument
Reimbursement Requests (Private)
Removed
0
0
0
Reimbursement Requests (Public)
Removed
0
0
0
Written Agreements (Private ) - Year 1
Removed
0
0
0
Written Agreements (Public) - Year 1
Removed
0
0
0
Total burden requested under this ICR:
18872
579704
0
To view an IC, click on IC Title