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

View Information Collection (IC)

QECP Application, Reapplication, DUA and ARW
 
No Modified
 
Voluntary
 
42 CFR 401.719(b) 42 CFR 401.703a 42 CFR 401.716 42 42 CFR 401.718 42 CFR 401.713

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10394 Yes Yes Fillable Fileable Signable
Form and Instruction CMS-10394 Yes No Fillable Printable
Form and Instruction CMS-10394 Yes No Fillable Printable
Instruction Yes No Printable Only
Form and Instruction CMS-10394 Yes No Fillable Printable
Form and Instruction CMS-10394 Yes Yes Fillable Printable
Form and Instruction CMS-10394 Yes Yes Fillable Printable
Form and Instruction CMS-10394 Yes Yes Fillable Printable
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Form and Instruction CMS-10394 Yes Yes Fillable Printable
Form and Instruction CMS-10394 Yes Yes Fillable Printable

Health Health Care Services

 

40 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 70 0 40 0 0 30
Annual IC Time Burden (Hours) 5,800 0 2,000 0 0 3,800
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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