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Information collections available for public comment.


CMS Form Number Date Subject
CMS-10407 2016-02-26 Summary of Benefits and Coverage Uniform Glossary
CMS-R-305 2015-05-26 External Quality Review (EQR) of Medicaid Managed Care, EQR Protocols, and Supporting Regulations
CMS-10221 2015-01-16 Site Investigation for Independent Diagnostic Testing Facilities (IDTFs)
CMS-R-185 2014-07-18 Granting and Withdrawal of Deeming Authority to Private Nonprofit Accreditation Organizations and of State Exemption Under State Laboratory Programs and Supporting Regulations
CMS-1880 and CMS-1882 2014-11-17 Certification as a Supplier of Portable X-Ray and Portable X-Ray Survey Report Form and Supporting Regulations
CMS-18F5 2014-02-14 Application for Hospital Insurance and Supporting Regulations
CMS-2540-10 2015-08-12 Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report Form
CMS-R-263 2015-01-16 Site Investigation for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
CMS-R-153 2016-01-29 Medicaid Drug Use Review (DUR) Program
CMS-855O 2016-03-25 Medicare Registration Application
CMS-10237 2015-09-24 Part C—Medicare Advantage and 1876 Cost Plan Expansion Application
CMS-10137 2015-09-24 Solicitation for Applications for Medicare Prescription Drug Plan 2017 Contracts
CMS-10291 2014-11-21 State Collection and Reporting of Dental Provider and Benefit Package Information on the Insure Kids Now! Web site and Hotline
CMS-10249 2015-03-25 Administrative Requirements for Section 6071 of the Deficit Reduction Act
CMS-R-235 2014-06-27 Data Use Agreement
CMS-209 2014-11-28 Laboratory Personnel Report (CLIA) and Supporting Regulations
CMS-R-246 2015-05-08 Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey
CMS-10418 2016-02-19 Annual Medical Loss Ratio (MLR) and Rebate Calculation Report and MLR Rebate Notices
CMS-64 2014-04-11 Medicaid Program Budget Report
CMS-37 2014-04-11 Medicaid Program Budget Report
CMS-10398 2015-09-14 Demonstration Programs to Improve Community Mental Health Services
CMS-R-148 2014-06-20 Limitations on Provider Related Donations and Health Care Related Taxes; Limitation on Payment to Disproportionate Share Hospitals
CMS-R-268 2014-06-13 MS Interactive Survey Tool
CMS-10142 2015-12-18 Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
CMS-R-262 2015-12-18 CY 2017 Plan Benefit Package (PBP) Software and Formulary Submission
CMS-372(S) 2015-05-22 Annual Report on Home and Community Based Services Waivers
CMS-10406 2016-02-05 Probable Fraud Measurement Pilot
CMS–10422 2014-11-17 Payments for Services Furnished by Certain Primary Care Providers and Supporting Regulations in 42 CFR 438.6, 438.804, 447.400, and 447.410
CMS-10432 2015-08-05 Procedural Requirements for the FY 2016 Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program
CMS-10419 2014-10-31 Transparency Reports and Reporting of Physician Ownership or Investment Interests (CMS-1612-F; RIN 0938-AS12)
CMS-R-245 2016-04-22 Hospice Quality Reporting Program
CMS-10485 2014-01-29 Evaluation of the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration: Provider Survey
CMS-10500 2015-05-01 Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) Survey
CMS-10502 2014-03-10 LTCH Quality Reporting Program: Program Evaluation
CMS-10503 2014-03-10 Inpatient Rehabilitation Facilities (IRF) Quality Reporting Program
CMS-10504 2014-03-10 Hospice Quality Reporting Program: Program Evaluation
CMS-10509 2014-04-18 Prospective Evaluation of Evidence-Based Community Wellness and Prevention Programs
CMS-10512 2014-02-07 Direct Service Workforce Resource Center CC Survey Instrument
CMS-10510 2014-06-27 Basic Health Program Report for Health Insurance Exchange Premium
CMS-102 & 105 2014-01-29 CLIA Budget Workload Reports and Supporting Regulations
CMS-10515 2014-01-31 Payment Collections Operations Contingency Plan
CMS-10462 2014-03-25 Community First Choice Option Evaluation
CMS-R-53 2014-02-14 Imposition of Cost Sharing Charges Under Medicaid and Supporting Regulations
CMS-10518 2014-06-02 Application for Participation in the Intravenous Immune Globulin (IVIG) Demonstration
CMS-10519 2015-09-25 Physician Quality Reporting System and the Electronic Prescribing Incentive Program Data Assessment, Accuracy and Incorrect Payments Identification Support
CMS-10520 2016-03-08 Marketplace Quality Standards
CMS-10521 2014-07-25 Improving Quality of Care in Medicaid and CHIP through Increased Access to Preventive Services, State Survey
CMS-10525 2014-05-23 Health Plan Monitoring System Level I and Level II Data Entry for the Program of All-Inclusive Care for the Elderly
CMS-10527 2016-04-27 Annual Eligibility Redetermination, Product Discontinuation and Renewal Notices
CMS-10529 2014-10-20 Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP
CMS-10536 2014-12-19 Medicaid Eligibility and Enrollment (EE) Implementation Advanced Planning Document (IAPD) Template
CMS-10537 2014-08-29 National Implementation of the Hospice Experience of Care Survey (CAHPs Hospice Survey)
CMS-10538 2015-03-25 Hospice Information for Medicare Part D Plans (formerly, Prior Authorization Form for Beneficiaries Enrolled in Hospice)
CMS-10530 2014-11-17 Ambulatory Surgical Center Quality Reporting (ASCQR) Program
CMS-10541 2014-11-26 Summary of Benefits and Coverage Plan Variations
CMS-10542 2015-02-13 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey Mode Experiment
CMS-10543 2015-02-13 Emergency Department Patient Experience of Care (EDPEC) Survey Mode Experiment
CMS-10341 2015-02-27 Affordable Care Act Information and Collection Requirements for Section 1115 Demonstration Projects
CMS-10241 2015-03-25 Survey of Retail Prices: Payment and Utilization Rates, and Performance Rankings
CMS-224-14 2015-08-04 Federally Qualified Health Center Cost Report Form
CMS-10545 2016-04-01 Outcome and Assessment Information Set (OASIS) OASIS-C2/ICD-10
CMS-R-306 2015-05-01 Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities (PRTFs) for Individuals Under Age 21 and Supporting Regulations
CMS-29 2015-01-23 Verification of Clinic Data—Rural Health Clinic Form and Supporting Regulations
CMS-10410 2015-06-26 Medicaid Program; Eligibility Changes under the Affordable Care Act of 2010
CMS-R-74 2015-06-26 Income and Eligibility Verification System Reporting and Supporting Regulations
CMS-2552-10 2015-02-06 Hospital and Hospital Health Care Complex Cost Report
CMS-10544 2015-02-12 Good Cause Processes (CMS-4159–F2; RIN 0938-AS20)
CMS-10555 2015-12-14 Small Business Health Options Program (SHOP) Effective Date and Termination Notice Requirements
CMS-10417 2015-02-27 Medicare Fee-for-Service Prepayment Medical Review
CMS-10102 2015-05-29 National Implementation of the Hospital CAHPS Survey
CMS-10550 2015-03-20 Hospital National Provider Survey
CMS-10551 2015-03-20 Nursing Home National Provider Survey
CMS-10556 2016-03-30 Medical Necessity and Contract Amendments Under Mental Health Parity
CMS-10141 2015-06-19 Medicare Prescription Drug Benefit Program
CMS-10552 2015-03-30 Electronic Health Record Incentive Program-Stage 3
CMS-179 2015-06-26 State Plan Under Title XIX of the Social Security Act (Base Plan Pages, Attachments, Supplements to Attachments)
CMS-10539 2015-07-02 Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies
CMS-10261 2015-09-18 Part C Medicare Advantage Reporting Requirements and Supporting Regulations
CMS-10185 2015-08-24 Medicare Part D Reporting Requirements and Supporting Regulations
CMS-10431 2015-04-30 PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program
CMS-437A & 437B 2015-05-15 State Agency Sheets for Verifying Exclusions From the Inpatient Prospective Payment System and Supporting Regulations
CMS-10554 2015-05-26 Children’s Health Insurance Program Managed Care and Supporting Regulations
CMS-10553 2015-05-26 Medicaid Comprehensive Quality Strategy (CQS) and Supporting Regulations
CMS-10108 2015-05-28 Medicaid Managed Care and Supporting Regulations
CMS–10565 2015-06-17 Off-Cycle Submission of Summaries of Model of Care Changes
CMS-643 2015-06-19 Hospice Survey and Deficiencies Report Form and Supporting Regulations
CMS-10575 2015-06-25 Generic Clearance for the Heath Care Payment Learning and Action Network
CMS-10568 2015-11-16 Rural Health Clinics (RHCs) Reporting of Healthcare Common Procedure Coding System (HCPCS) and Other Codes as Required for RHC Claims and Supporting Regulations in 42 CFR 405.2462(g)(3)
CMS-10570 2015-11-16 Appropriate Use Criteria for Advanced Diagnostic Imaging Services
CMS–10276 2015-07-15 The Physician Quality Reporting System
CMS-R-234 2015-11-16 Subpart D - Private Contracts and Supporting Regulations Contained in 42 CFR 405.410, 405.430, 405.435, 405.440, 405.445, and 405.455
CMS-10569 2015-07-01 Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb)
CMS-10110 2015-07-21 Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biological and Supporting Regulations
CMS-10387 2015-07-21 Skilled Nursing Facility (SNF) Prospective Payment System and Consolidated Billing: Change of Therapy (COT) OMRA (Other Medicare required Assessment)
CMS-10250 2015-07-08 Hospital Outpatient Quality Reporting (OQR) Program
CMS-10572 2016-04-29 Information Collection for Transparency in Coverage Reporting by Qualified Health Plan Issuers
CMS-10143 2015-08-12 Monthly File of Medicaid/Medicare Dual Eligible Enrollees
CMS-10564 2015-12-28 Home Health Face-to-Face Encounter Clinical Templates
CMS-10393 2015-07-21 Medicare Beneficiary and Family-Centered Satisfaction Survey
CMS-1771 2015-09-21 Emergency and Foreign Hospital Services
CMS-10583 2015-09-25 Data collection for Medicare Beneficiaries Receiving Beta Amyloid Positron Emission Tomography (PET) for Dementia and Neurodegenerative Disease
CMS-906 2015-10-02 Fiscal Soundness Reporting Requirements
CMS-10079 2015-10-09 Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR Section 412.64
CMS-10565 2015-10-05 Initial and Renewal Model of Care Submissions, and Off-cycle Submission of Summaries of Model of Care Changes
CMS–10003 2016-03-11 Notice of Denial of Medical Coverage (or Payment)
CMS-10467 2015-10-16 Evaluation of the Graduate Nurse Education Demonstration Program
CMS-1450 2015-10-16 Medicare Uniform Instructional Provider Bill and Supporting Regulations 42 CFR 424.5
CMS-1500 2015-10-16 Health Insurance Claims form
CMS-10280 2016-03-11 Home Health Change of Care Notice (HHCCN)
CMS–10391 2015-11-02 Methods for Assuring Access to Covered Medicaid Services
CMS-R-131 2015-11-09 Advance Beneficiary Notice of Noncoverage (ABN)
CMS-10325 2016-02-19 Disclosure and Recordkeeping Requirements for Grandfathered Health Plans under the Affordable Care Act
CMS-10330 2016-02-19 CMS-10330 - Enrollment Opportunity Notice Relating to Lifetime Limits; Required Notice of Rescission of Coverage; and Disclosure
CMS-10595 2016-03-08 CMS-10595 - Third Party Payment of QHP Premiums and Additional Notices for QHP Issuers Data Collection
CMS-10338 2015-11-18 CMS-10338 - Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers
CMS-10066 2015-11-27 Detailed Notice of Discharge (DND) and Supporting Regulations in 42 CFR 405.1206 and 422.622
CMS-10400 2016-03-04 Establishment of Qualified Health Plans and American Health Benefit Exchanges
CMS-10594 2016-03-08 Provider Network Coverage
CMS-10440 2016-03-25 Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and Children's Health Insurance Program Agencies
CMS-10596 2015-11-27 Reapplication Submission Requirement for Qualified Entities under ACA Section 10332
CMS-10593 2015-12-02 Establishment of an Exchangeby a State and Qualified Health Plans
CMS-10430 2016-03-01 Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act
CMS-10592 2016-03-18 Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers
CMS-10333 2016-01-20 Consumer Assistance Program Grants
CMS-855S 2015-09-11 CMS-855S - Medicare Enrollment Application – Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
CMS-R-193 2015-12-08 Important Message From Medicare in 42 CFR 405.1205 and 422.620
CMS-R-244 2015-12-08 The PACE Organization (PO) Application Process in Part 460 of 42 C.F. R.
CMS-10434 2016-03-28 Medicaid and CHIP Program (MACPro)
CMS-10438 2016-03-25 Data Collection to Support Eligibility Determinations and Enrollment for Employees in the Small Business Health Options Program
CMS-10439 2016-03-25 Data Collection to Support Eligibility Determinations and Enrollment for Small Businesses in the Small Business Health Options
CMS-R-282 2015-12-14 Medicare Advantage Appeals and Grievance Data Disclosure Requirements and Supporting Regulations (42 CFR 422.111)
CMS-359 & 360 2016-01-04 Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms and Supporting Regulations
CMS-R-284 2015-12-31 Medicaid Statistical Information System (MSIS) and Transformed—Medicaid Statistical Information System (T–MSIS)
CMS-10599 2016-02-05 Medicare Prior Authorization of Home Health Services Demonstration
CMS-10379 2016-02-19 Rate Increase Disclosure and Review Reporting Requirements
CMS-846-849, 854, 10125 and 10126 2016-02-19 Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation
CMS-484 2016-02-19 Attending Physician's Certification of Medical Necessity for Home Oxygen Therapy and Supporting Regulations
CMS-P-0015A 2016-02-24 Medicare Current Beneficiary Survey
CMS-3427 2016-02-26 End Stage Renal Disease Application and Survey and Certification Report
CMS-685 2016-02-26 End-Stage Renal Disease (ESRD) Network Semi-Annual Cost Report Forms and Supporting
CMS-576A 2016-02-26 Organ Procurement Organization’s Health Insurance Benefits Agreement and Supporting
CMS-10601 2016-02-26 CMS Innovation Partners Program Applications and Surveys
CMS-R-199 2016-03-02 Medicaid Report on Payables and Receivables
CMS-10576 2016-03-02 CMS-10576 - Medicare and Medicaid Program; Program Integrity Enhancements to the Provider Enrollment Process
CMS-10146 2016-03-11 Notice of Denial of Medicare Prescription Drug Coverage
CMS-10409 2016-03-11 LTCH CARE Data Set For the Collection of Data Pertaining to the Long-Term Care Hospital Quality Reporting Program
CMS-10377 2016-03-11 Student Health Insurance Coverage
CMS-10465 2016-03-11 Minimum Essential Coverage
CMS-10316 2016-03-25 Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare Advantage (MA) Plan Disenrollment Reasons Survey
CMS-10615 2016-03-29 Healthy Indiana Program (HIP) 2.0 Beneficiaries Survey
CMS-10600 2016-02-10 Evaluation of the Medicare Patient Intravenous Immunoglobulin Demonstration
CMS-10309 2016-04-01 Grandfathering Provisions of the Medicare DMEPOS Competitive Bidding Program
CMS-10468 2016-04-01 Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment
CMS-855 (A B I) 2016-04-01 Medicare Enrollment Application
CMS-10611 2016-04-27 Medicare Outpatient Observation Notice
CMS-1490 2016-04-22 Patient’s Request for Medical Payment