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

View Information Collection (IC)

Reconciliation of State Invoice and Prior Quarter Adjustment Statement (CMS-304A)
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-304a No No Paper Only
Instruction No No Paper Only
Other-Other No No Paper Only
Other-Other No No Paper Only

Health

 

550 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 2,200 0 2,200 0 0 0
Annual IC Time Burden (Hours) 44,000 0 44,000 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.
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