Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(Cycle I) Final Report Removed 0 0 0 Form and Instruction CMS-10380 Cycle I FOA
Form and Instruction CMS-10380 Cycle 1 - Final report template
(Cycle I) Quarterly Reports Removed 0 0 0 Form and Instruction CMS-10380 Cycle I - Quarterly Report
(Cycle I) Transaction Data Collection Removed 0 0 0 Form and Instruction CMS-10380 Cycle I FOA
(Cycle II ) Final Report - end of grant Removed 0 0 0 Form and Instruction CMS-10380 Cycle II FOA
(Cycle II) Annual Report Removed 0 0 0 Form and Instruction CMS-10380 Cycle II FOA
(Cycle II) Quarterly Report Removed 0 0 0 Form and Instruction CMA-10380 Cycle II FOA
Form and Instruction CMS-10380 Cycle II - Quarterly Report Template
(Cycle II) Transaction Data Collection Removed 0 0 0 Form and Instruction CMS-10380 Cycle II FOA
(Cycle III) Annual Report Removed 0 0 0 Form and Instruction CMS-10380 Cycle III - Annual Reporting Template
(Cycle III) Application Removed 0 0 0 Other-Data
(Cycle III) Final Report Removed 0 0 0 Form and Instruction CMS-10380 Cycle III - Final Report Template
(Cycle III) Quarterly Report Removed 0 0 0 Form and Instruction CMS-10380 Cycle III - Quarterly Report Template
(Cycle III) Transaction Data Collection Removed 0 0 0 Form and Instruction CMS-10380 Cycle III - Data
Effective Rate Review Program New 49 245 0
Rate Review Grant - Cycle IV Annual Report New 42 1680 0 Form and Instruction CMS-10380 Rate Review Grant cycle IV - Annual Report
Rate Review Program Grant - Cycle IV Application New 42 6678 0
Rate Review Program Grant - Cycle IV Final Report New 42 1680 0
Rate Review Program Grant - Cycle IV Quarterly Report New 168 4368 0 Form and Instruction CMS-10380 Rate Review Program Quarterly Report
Transaction Data Collection New 210 6300 0 Form CMS-10380 Grant Program Data Dictionary
Total burden requested under this ICR: 553 20951 0  
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