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View Information Collection (IC)

View Information Collection (IC)

Creation of Model Notices (Plans) (section 423.120(c)(6))
 
No Removed
 
Mandatory
 
42 CFR 423.120(c)(6)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Yes Yes Printable Only
Form and Instruction CMS-10141 Yes Yes Fillable Fileable
Form and Instruction CMS-10141 Yes Yes Fillable Fileable
Form and Instruction CMS-10141 Yes Yes Fillable Fileable

Health Health Care Services

 

212 0
   
Private Sector 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 0 0 0 -212 0 212
Annual IC Time Burden (Hours) 0 0 0 -636 0 636
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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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