View Information Collection (IC)

View Information Collection (IC)

GenIC #74 (Revised): Coverage of Routine Patient Cost for Items & Services in Qualifying Clinical Trials CMCS
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10398 #74 Qualifying Clinical Trial Preprint (Attachment 3.1-A) Preprint Att. 3.1-A (2022 version 3).pdf Yes Yes Fillable Fileable
Form CMS-10398 #74 Qualifying Clinical Trial Preprint (Attachment 3.1-B) Preprint Att. 3.1-B (2022 version 3).pdf Yes Yes Fillable Fileable
Form n/a HHS Qualifying Clinical Trial Attestation Form REVISED QUALIFYING CLINICAL TRIAL ATTESTATION FORM Clean 3.17.22 - 508.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 66 0 66 0 0 0
Annual IC Time Burden (Hours) 5 0 5 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement #74 - Generic Supporting Statement (2022 version 7).docx 04/13/2022
Public Comment SCRS Comment.pdf 04/13/2022
Response to Public Comment Response to Comments.pdf 04/13/2022
Crosswalk: Qualifying Clinical Trial Attestation Form Crosswalk - Qualifying Clinical Trials Attestation Form 03-29-2022.pdf 04/13/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.