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

View Information Collection (IC)

Essential Community Provider Petition
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMs-10561 Yes Yes Fillable Fileable
Form and Instruction CMS-10561 Yes No Fillable Fileable

Health Public Health Monitoring

 

31,634 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 31,634 31,634 0 0 0 0
Annual IC Time Burden (Hours) 53,491 53,491 0 0 0 0
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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