Information Collection

National Medicare Training Program Needs Assessment Survey (Private Sector)

IC 186881 under ICR 200810-0938-010 · OMB 0938-1063.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10257 National Medicare Training Program Needs Assessment Survey (Private Sector)	Form and Instruction
CMS-10257 CMS-10257. Collection Instrument - Phone Version CLEAN-DRAFT NMTP Needs Assessment Survey_PHONE VERSION_042109.doc	Form and Instruction
CMS-10257 CMS-10257. Collection Instrument - Web Version CLEAN-DRAFT NMTP Needs Assessment Survey_WEB VERSION_042109.doc	Form and Instruction
Survey DRAFT email reminder_012408Fi _2_.pdf CMS-10257. Email Reminder	IC Document

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-10257	CMS-10257. Collection Instrument - Web Version	CLEAN-DRAFT NMTP Needs Assessment Survey_WEB VERSION_042109.doc		Yes	No	Fillable Fileable
Form and Instruction	CMS-10257	CMS-10257. Collection Instrument - Phone Version	CLEAN-DRAFT NMTP Needs Assessment Survey_PHONE VERSION_042109.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,720

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,720	1,720
Annual IC Time Burden (Hours)	430	430
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10257. Email Reminder	Survey DRAFT email reminder_012408Fi _2_.pdf	08/26/2008

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