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

View Information Collection (IC)

RIF Request Packet CMS-R-235
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-R-235 RIF Request Application Attachment A - RIF Request Application .docx Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 State Agency Supplement 06State-Agency-Supplement-final.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 Innovator Supplement 05Innovator-Supplement-final.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 Collaborator Supplement 04Collaborator-Supplement-final.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 Key Personnel Supplement 03Key-Personnel-final.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 Amendment Request Form 08RIF-Amendment-final-508.docx Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 RIF Extenstion Request Form RIF Extenstion Request Form.docx Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 RIF DUA Signature Addendum RIF DUA Signature Addendum.docx Yes Yes Fillable Fileable

Health Health Care Services

 

3,455 0
   
Private Sector 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 3,455 0 750 0 0 2,705
Annual IC Time Burden (Hours) 1,624 0 375 0 0 1,249
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change - RIF Application Attachment A - RIF Application REDLINE.pdf 05/27/2025
Track Change - RIF Amendment RIF-Amendment REDLINE.pdf 05/27/2025
RIF Amendment_JobAid RIF Amendment_JobAid.pdf 05/27/2025
RIF Application_JobAid RIF Attachment A_JobAid.pdf 05/27/2025
RIF Extension Request_JobAid RIF Extension Request_JobAid.pdf 05/27/2025
RIF Signature Addendum_JobAid RIF Signature Addendum_JobAid.pdf 05/27/2025
IT system - Data collection fields Form Fields .docx 05/29/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.