Information Collection

Physician Survey for the 2006 Medicare Oncology Demonstration Program (CMS-10217)

IC 181325 under ICR 200707-0938-011 · OMB 0938-1031.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10217 2006 Medicare Oncology Demonstration Program: Physian Survey Physician Survey for the 2006 Medicare Oncology Demonstration Program (CMS-10217)	Form and Instruction
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

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10217	Yes	Yes	Paper Only
Other-Advance Letter		Yes	Yes	Paper Only
Other-Cover Letter		Yes	Yes	Paper Only
Other-Follow-up Letter		Yes	Yes	Paper Only
Other-National Cancer Institute Letter		Yes	Yes	Paper Only

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	100	100
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.

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