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Qualification-Medicare Advantage Application for Coordinated Care Private Fee-For-Service, Regional Preferred Preferred Provider Organization, Service Area Expansion for Coordinated Care.......
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10117 Yes Yes
Form CMS-10118 Yes Yes
Form CMS-10136 Yes Yes
Form CMS-10135 Yes Yes
Form CMS-10119 Yes Yes


    

350 0
   
Private Sector Businesses or other for-profits
 
   50 %

  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 350 0 350 0 0 0
Annual IC Time Burden (Hours) 20,100 0 20,100 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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