Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application Modified 50 28200 42770 Instruction
Form and Instruction CMS-10371 FOA
Performance Reviews Modified 50 5750 0 Form and Instruction CMS-10371 FOA
Instruction
Periodic Reporting Modified 100 10600 0 Instruction
Form and Instruction CMS-10371 FOA
Public Modified 200 1700 0 Form and Instruction CMS-10371 FOA
Instruction
Quarterly Modified 200 23000 0 Form and Instruction CMS-10371 Quarterly Instrument
Form and Instruction CMS-10371 Quarterly Data Elements
Form and Instruction CMS-10371 Quarterly Instrument Revised
Form and Instruction CMS-10371 Quarterly Data Elements Revised
Work Plan Update Modified 100 400 0 Form and Instruction CMS-10371 FOA
Total burden requested under this ICR: 700 69650 42770  
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