OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Survey of Newly Eligible Medicare Beneficiaries

IC 43669 under ICR 200910-0938-017 · OMB 0938-0869.

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

View Information Collection (IC)

Survey of Newly Eligible Medicare Beneficiaries
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10050 Survey of Newly Eligible Medicare Beneficiaries CMS-10050.Collection Instrument.doc No No Fillable Fileable

Health Health Care Services

 

1,200 0
   
Individuals or Households
 
   0 %

  Requested 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 1,200 0 -1,200 0 0 2,400
Annual IC Time Burden (Hours) 300 0 -500 0 0 800
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.