Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(Cycle I) Final Report Modified 51 2040 0 Form and Instruction CMS-10380 Cycle I FOA
Form and Instruction CMS-10380 Cycle 1 - Final report template
(Cycle I) Quarterly Reports Modified 20 480 0 Form and Instruction CMS-10380 Cycle I - Quarterly Report
(Cycle I) Transaction Data Collection Modified 204 8160 0 Form and Instruction CMS-10380 Cycle I FOA
(Cycle II ) Final Report - end of grant Modified 34 1360 0 Form and Instruction CMS-10380 Cycle II FOA
(Cycle II) Annual Report Modified 34 1360 0 Form and Instruction CMS-10380 Cycle II FOA
(Cycle II) Application Removed 0 0 0 Form and Instruction CMS-10380 Cycle II - FOA
(Cycle II) Quarterly Report Modified 224 5376 0 Form and Instruction CMA-10380 Cycle II FOA
Form and Instruction CMS-10380 Cycle II - Quarterly Report Template
(Cycle II) Transaction Data Collection Modified 224 8960 0 Form and Instruction CMS-10380 Cycle II FOA
(Cycle III) Annual Report New 56 2240 0 Form and Instruction CMS-10380 Cycle III - Annual Reporting Template
(Cycle III) Application New 56 8960 0 Other-Data
(Cycle III) Final Report New 56 2240 0 Form and Instruction CMS-10380 Cycle III - Final Report Template
(Cycle III) Quarterly Report New 224 5824 0 Form and Instruction CMS-10380 Cycle III - Quarterly Report Template
(Cycle III) Transaction Data Collection New 280 8400 0 Form and Instruction CMS-10380 Cycle III - Data
Total burden requested under this ICR: 1463 55400 0  
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