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

View Information Collection (IC)

CMS-10805 and CMS-10806 CSQ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10805 Yes Yes Fillable Fileable
Form and Instruction CMS-10806 Yes Yes Fillable Fileable

Health Health Care Services

 

3,000 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 3,000 0 3,000 0 0 0
Annual IC Time Burden (Hours) 750 0 750 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10805 Supporting Statement 03/16/2022
CMS-10806 Supporting Statement 03/16/2022
Burden Table 03/16/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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