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

View Information Collection (IC)

LAN Documents (CMS-10612, CMS-10613 and CMS-10614)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10612 Yes Yes Fillable Fileable
Form and Instruction CMS-10613 Yes Yes Fillable Fileable
Form and Instruction CMS-10614 Yes Yes Fillable Fileable

Health Health Care Services

 

4,400 880
   
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 4,400 0 4,400 0 0 0
Annual IC Time Burden (Hours) 231 0 231 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10612 Supporting Statement 03/23/2016
CMS-10613 Supporting Statement 03/23/2016
CMS-10614 Supporting Statement 03/23/2016
0938-1297 Burden Table for GenICs 7 8 and 9 03/23/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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