Information Collection

Survey of Contract Labor in Selected Health Industries

IC 183298 under ICR 200801-0938-001 · OMB 0938-1036.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10177 Survey of Contract Labor in Selected Health Industries	Form and Instruction
CMS-10177[1].Draft Cover Letter.doc	Other-Survey Cover Letter
CMS-10177 CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND CMS-10177[1].REVISED-Survey Instrument.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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10177	CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND KIDNEY DIALYSIS CENTERS	CMS-10177[1].REVISED-Survey Instrument.doc		Yes	Yes	Fillable Fileable
Other-Survey Cover Letter			CMS-10177[1].Draft Cover Letter.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,640

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	3,640	3,640
Annual IC Time Burden (Hours)	3,640	3,640
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.