OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Evaluation of Care and Disease Management Under Medicare Advantage (CMS-10255)

IC 184936 under ICR 200805-0938-006 · OMB 0938-1048.

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

View Information Collection (IC)

Evaluation of Care and Disease Management Under Medicare Advantage (CMS-10255)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey, Form and Letters Revised Collection Instruments.doc Yes Yes Paper Only

Health Health Care Services

 

475 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   50 %

  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 475 0 475 0 0 0
Annual IC Time Burden (Hours) 435 0 435 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cross-walk document and Track Changes Cross-walk document and Track Changes.doc 04/29/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.