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Federal forms, ICRs, and supporting documents

Information Collection

Medicare Health Survey (MHS) and Data Collection for Administering the PACE Health Survey to Beneficiaries Enrolled in PACE and the Dual Eligible Demonstrations

IC 37914 under ICR 200409-0938-006 · OMB 0938-0844.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
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Information Collection (IC) Details

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Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10024 No No

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 10,785 0 0 0 0 10,785
Annual IC Time Burden (Hours) 1,798 0 0 0 0 1,798
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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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