Information Collection

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

IC 181308 under ICR 200707-0938-010 · OMB 0938-1030.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10223 CAP_OMB_package_revised(3) 12_12_07.doc	Other-Advance Letter,Cover Letter,Fo

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.