OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

(CMS-10310) - Initial Screening

IC 191849 under ICR 201001-0938-005 · OMB 0938-1081.

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

View Information Collection (IC)

(CMS-10310) - Initial Screening
 
  New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10310 Attachment B2_Screening Form_Caregivers CMS-10310.Attachment B2_Screening Form_Caregivers_REV.doc Yes No Fillable Fileable
Form and Instruction CMS-10310 Attachment B1_Screening Form_Consumers CMS-10310.Attachment B1_Screening Form_Consumers_REV.doc Yes No Fillable Fileable
Form and Instruction CMS-10310 Attachment B3_Screening Form_Professionals_REV CMS-10310.Attachment B3_Screening Form_Professionals_REV.doc Yes No Fillable Fileable

Health Health Care Services

 

80 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 80 0 80 0 0 0
Annual IC Time Burden (Hours) 7 0 7 0 0 0
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.