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

View Information Collection (IC)

Three-Year Network Adequacy Review for Medicare Advantage Organizations
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CY 2018 HSD Instructions_011017 - Final for 0938-New - 072417.pdf Yes No Printable Only
Form CMS-10636 Provider Table CY_2018 _Provider_HSD_Table_Final - Final for 0938-New - 072417.pdf Yes Yes Fillable Fileable
Form CMS-10636 Facility Table CY_2018_Facility_HSD_Table_Final - Final for 0938-New - 072417.pdf Yes Yes Fillable Fileable
Form CMS-10636 Exception Template CY_2018_MA_HSD_Exception_Request_Template - Final for 0938-New - 072417.pdf Yes Yes Fillable Fileable
Form CMS-10636 Justification Template CY_2018_Partial_County_Justification_Template - Final for 0938-New - 072417.pdf Yes Yes Fillable Fileable
Instruction NMM_OrgQuickReferenceUserGuide2.pdf Yes No Printable Only
Other-Notice of Network Review Letter NoticeOfEntireNetworkReviewLetter - Final for 0938-New - 072417 (rev OSORA PRA).pdf Yes No Printable Only

Health Health Care Services

 

304 0
   
Private Sector 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 1,652 0 1,652 0 0 0
Annual IC Time Burden (Hours) 15,692 0 15,692 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.