Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Monthly Data Reports New 3450 41400 0 Form and Instruction CMS-10515 Copy of Enrollment and Payment Data Template
Monthly Data Submission Accuracy Certification Form New 3450 575 0 Form and Instruction CMS-10515 Enrollment and Payment Data Template Submission Accuracy Certification Form
Payment Collections Operations Contingency Plan New 575 9200 0 Form and Instruction CMS-10515 SBM Isser Payment Report
Testing & Development New 400 1200 0
Total burden requested under this ICR: 7875 52375 0  
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