Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Reconciliation of State Invoice and Prior Quarter Adjustment Statement (CMS-304) Modified 1540 95480 0 Form CMS-304 Reconciliation of State Invoice
Other-Other
Instruction
Other-Other
Reconciliation of State Invoice and Prior Quarter Adjustment Statement (CMS-304A) Modified 2280 45600 0 Form CMS-304a Prior Quarter Adjustment Statement
Instruction
Other-Other
Other-Other
Other- PQAS Form With Disclosure Statement
Total burden requested under this ICR: 3820 141080 0  
To view an IC, click on IC Title