View Information Collection (IC)

View Information Collection (IC)

States - Data Collection
No Modified

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10320 Appendix E - State Requirements CMS-10320 - Appendix_E_StateRequirements.pdf Yes No Paper Only
Form and Instruction CMS-10320 State Instructions and Application CMS-10320.FINAL State Instructions and Instrument (5-5-10).pdf Yes No Fillable Fileable

Health Health Care Services


50 0
State, Local, and Tribal Governments
   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 50 0 0 0 0 50
Annual IC Time Burden (Hours) 400 0 0 0 0 400
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.