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

View Information Collection (IC)

LAN Documents (CMS-10616, CMS-10617 and CMS-10618)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10616 Yes Yes Fillable Fileable
Form and Instruction CMS-10617 Yes Yes Fillable Fileable
Form and Instruction CMS-10618 Yes Yes Fillable Fileable

Health Health Care Services

 

1,680 336
   
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 1,680 0 1,680 0 0 0
Annual IC Time Burden (Hours) 56 0 56 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Burden Table for GenIC#10 11 and 12 04/14/2016
CMS-10616 Supporting Statement 04/14/2016
CMS-10617 Supporting Statement 04/14/2016
Supporting Statement 10618 04/14/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.