Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Initial, Renewal, and Re-Submissions Modified 425 2505 0 Form CMS-10565 Model of Care Requirements for Medicare Advantage Special Needs Plans
Off-cycle Submission Modified 150 600 0 Form CMS-10565 Model of Care Requirements for Medicare Advantage Special Needs Plans
Tracking Face-to-Face Encounters (all SNP types) Modified 1340 5360 0 Form CMS-10565 Model of Care Requirements for Medicare Advantage Special Needs Plans
Training Removed 0 0 0
Total burden requested under this ICR: 1915 8465 0  
To view an IC, click on IC Title