Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Initial and renewal MOC Submissions Unchanged 220 1320 0 Form CMS-10565 Model of Care Matrix Upload Document for Initial Application and Renewal
Form CMS-10565 Model of care matrix upload document for initial application and renewal
Off-cycle Submission of Summaries (MOC Changes) Unchanged 103 412 0 Form CMS-10565 Revised Model of Care Matrix Upload Document
Form CMS-10565 Revised Model of Care Matrix Upload Document
Total burden requested under this ICR: 323 1732 0  
To view an IC, click on IC Title