PRA IC List
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Three-Year Network Adequacy Review for Medicare Advantage Organizations
Modified
2753
27470
0
Instruction
Form
CMS-10636
Provider HSD Table
Form
CMS-10636
Facility HSD Table
Form
CMS-10636
Exception Request Template
Form and Instruction
CMS-10636
Partial County Justification Template
Other-Screen Shot: HPMS Web Based Application
Other-Screen Sot: LOI Upload Page
Form
CMS-10636
LOI Group to NPI Matrix Template
Total burden requested under this ICR:
2753
27470
0
To view an IC, click on IC Title
An official website of the United States government
The .gov means it's official.
The site is secure.
