View Information Collection (IC)

View Information Collection (IC)

Monthly Data Reports
No New
Required to Obtain or Retain Benefits
45 CFR 156.430

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10515 Copy of Enrollment and Payment Data Template CMS-10515 - Copy of Enrollment and Payment Data Template 12 1 13v3.xlsx Yes Yes Fillable Fileable

Health Health Care Services


575 0
Private Sector Businesses or other for-profits, Not-for-profit institutions
   6 %

  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 3,450 3,450 0 0 0 0
Annual IC Time Burden (Hours) 41,400 41,400 0 0 0 0
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.