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

View Information Collection (IC)

Individuals
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10500 No   Fillable Fileable
Form and Instruction CMS-10500 Yes Yes Fillable Fileable
Form and Instruction CMS-10500 Yes Yes Fillable Fileable
Form and Instruction CMS-10500 Yes Yes Fillable Fileable
Form and Instruction CMS-10500 Yes Yes Fillable Fileable
Form and Instruction CMS-10500 Yes Yes Fillable Fileable
Form and Instruction CMS-10500 Yes Yes Fillable Fileable
Form and Instruction CMS-10500 Yes Yes Fillable Fileable

Health Health Care Services

 

2,037,300 0
   
Individuals or Households
 
   0 %

  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 2,037,300 0 -487,100 0 0 2,524,400
Annual IC Time Burden (Hours) 264,849 0 -63,323 0 0 328,172
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letters 02/12/2026
Letter Invitation for Web Survey 02/12/2026
Initial Web Survey Invitation Email 02/12/2026
Follow up Web Survey Invitation Letter 02/12/2026
Follow up Web Survey Invitation Email 04/07/2026
Web with Mail Followup_Questionnaire Cover Letter 04/07/2026
Prenote Letter for Telephone Only 04/07/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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