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

View Information Collection (IC)

LAN Documents (CMS-10602, CMS-10603 and CMS-10604)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10603 Yes Yes Fillable Fileable
Form and Instruction CMS-10604 Yes Yes Fillable Fileable
Form and Instruction CMS-10602 Yes Yes Fillable Fileable

Health Health Care Services

 

4,850 128
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 4,850 0 4,850 0 0 0
Annual IC Time Burden (Hours) 648 0 648 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10602 Supporting Statement 02/11/2016
CMS-10603 Supporting Statement 02/11/2016
Burden Table for GenIC #1, 2 and 3 02/11/2016
CMS-10604 Supporting Statement 02/11/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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