Medicare Competitive Acquisition Program (CAP) for Part B Drugs Evaluation: CAP Physician Survey (CMS-10223)

Medicare Competitive Acquisition Program (CAP) for Part B Drugs Evaluation: CAP Physician Survey

Documents and Forms

Document Name Document Type
CMS-10223 CAP_OMB_package_revised(3) 12_12_07.doc Other-Advance Letter,Cover Letter,Fo

Information Collection (IC) Details

IC Title:	Medicare Competitive Acquisition Program (CAP) for Part B Drugs Evaluation: CAP Physician Survey (CMS-10223)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Advance Letter,Cover Letter,Follow-up Letter, Frequently Asked Questions, CAP Participating Survey and CAP NON-Participating Survey			CMS-10223 CAP_OMB_package_revised(3) 12_12_07.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,560	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,560	1,560
Annual IC Time Burden (Hours)	297	297
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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