OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Evaluation of the Medical Adult Day-Care Services Demonstration - Phase I

IC 178665 under ICR 200805-0938-005 · OMB 0938-1017.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Evaluation of the Medical Adult Day-Care Services Demonstration - Phase I
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10204 CMS-10204 - Instruments (Appendices B,C,D,E) CMS-10204.Draft Supporting Statement.8-1-06.doc No No Printable Only

Health Health Care Services

 

50 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   55 %

  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 0 0 -50 0 0 50
Annual IC Time Burden (Hours) 0 0 -38 0 0 38
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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