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

View Information Collection (IC)

Administrative Requirements for Section 6071 of the DRA
 
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 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
Form and Instruction CMS-10249 Yes Yes Fillable Fileable
Form and Instruction CMS-10249 Yes Yes Fillable Fileable

Health Health Care Services

 

42 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 336 0 -16 0 0 352
Annual IC Time Burden (Hours) 2,604 0 -564 0 0 3,168
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk: Semi-Annual Progress Report 07/22/2021
Crosswalk: Additional Benchmarks – Addendum to the MFP Semi-Annual Progress Report 07/22/2021
Crosswalk: MFP_Semi-Annual_Help_File 07/22/2021
Crosswalk: MFP_Budget_Workbook 07/22/2021
Crosswalk: MFP MOE Form 07/22/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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