PRA IC List
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Agenda
Reg Review
ICR
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
1664
116480
0
Form
CMS-304
Reconciliation of State Invoice (ROSI)
Other-Appendix
Instruction
Other-Appendix
Reconciliation of State Invoice and Prior Quarter Adjustment Statement (CMS-304A)
Modified
2380
66640
0
Form
CMS-304a
Prior Quarter Adjustment Statement (PQAS)
Instruction
Other-Appendix
Other-Appendix
Total burden requested under this ICR:
4044
183120
0
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