Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Prior Quarter Adjustment Statement (PQAS) (CMS-304A) Modified 2628 73584 0 Form CMS-304a
Instruction
Instruction
Instruction
Reconciliation of State Invoice (ROSI) (CMS-304) Modified 1840 128800 0 Instruction
Form CMS-304
Instruction
Instruction
Total burden requested under this ICR: 4468 202384 0  
To view an IC, click on IC Title