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Physician Survey for the 2006 Medicare Oncology Demonstration Program (CMS-10217)
Physician Survey for the 2006 Medicare Oncology Demonstration Program
OMB: 0938-1031
IC ID: 181325
OMB.report
HHS/CMS
OMB 0938-1031
ICR 200707-0938-011
IC 181325
( )
Documents and Forms
Document Name
Document Type
5_Appendix B_Advance Letter.doc
Other-Advance Letter
6_Appendix C_Cover Letter.doc
Other-Cover Letter
7_Appendix D_Follow up Letter.doc
Other-Follow-up Letter
8_NCI_Support_ Letter.doc
Other-National Cancer Institute Lett
CMS-10217 2006 Medicare Oncology Demonstration Program: Physian Su
4_Appendix A_Physician Survey.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Physician Survey for the 2006 Medicare Oncology Demonstration Program (CMS-10217)
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-Follow-up Letter
7_Appendix D_Follow up Letter.doc
Yes
Yes
Paper Only
Other-Cover Letter
6_Appendix C_Cover Letter.doc
Yes
Yes
Paper Only
Other-Advance Letter
5_Appendix B_Advance Letter.doc
Yes
Yes
Paper Only
Form and Instruction
CMS-10217
2006 Medicare Oncology Demonstration Program: Physian Survey
4_Appendix A_Physician Survey.doc
Yes
Yes
Paper Only
Other-National Cancer Institute Letter
8_NCI_Support_ Letter.doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
600
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
600
0
600
0
0
0
Annual IC Time Burden (Hours)
100
0
100
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.