Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Initial and renewal MOC Submissions Modified 287 1680 0 Form CMS-10565 Model of care matrix upload document for initial application and renewal
Off-cycle Submission of Summaries (MOC Changes) Modified 139 556 0 Form CMS-10565 Revised Model of Care Matrix Upload Document
Tracking Face-to-Face Encounters New 734 2936 0
Training New 273 819 0
Total burden requested under this ICR: 1433 5991 0  
To view an IC, click on IC Title