OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Evaluation of the Medical Adult Day Care Services Demonstration (CMS-10204)

IC 178664 under ICR 200805-0938-005 · OMB 0938-1017.

Documents and Forms
Document Name
Document Type
Other-Form, Instructions and Appendi
Information Collection (IC) Details

View Information Collection (IC)

Evaluation of the Medical Adult Day Care Services Demonstration (CMS-10204)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Form, Instructions and Appendices (CMS-10204) REVISEDfinalOMB1.25.08supportingstatement.doc Yes Yes Paper Only

Health Health Care Services

 

900 0
   
Individuals or Households
 
   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 900 0 640 0 0 260
Annual IC Time Burden (Hours) 150 0 -110 0 0 260
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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