View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Administrative Requirements for Section 6071 of the DRA (CMS-10249)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10249 Yes Yes Fillable Fileable
Form and Instruction CMS-10249 Yes Yes Fillable Printable
Form CMS-10249 Yes Yes Fillable Printable
Form and Instruction CMS-10249 Yes Yes Fillable Printable
Instruction Yes Yes Fillable Printable
Form CMS-64.9i, -64.9pi, -64.10i, and -64.910pi, Yes No Fillable Printable

Health Health Care Services

 

44 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 352 0 -8 -28,215 28,575 0
Annual IC Time Burden (Hours) 3,168 0 408 -11,460 14,220 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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