Non-Statistical Data - Private Sector (Focus Groups)

Evaluation of Medicare National Competitive Bidding Program for DME

Documents and Forms

Document Name Document Type
Form CMS-10197 Non-Statistical Data - Private Sector (Focus Groups) Form and Instruction
CMS-10197 CMS-10197 AppendixC-NonstatisticalInstruments CMS-10197 AppendixC-NonstatisticalInstruments11_6_508ready.pdf Form and Instruction
CMS-10197 CMS-10197 AppendixD-InfConsentFormsScripts CMS-10197 AppendixD-InfConsentFormsScripts11_6_508ready.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Non-Statistical Data - Private Sector (Focus Groups)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10197	CMS-10197 AppendixC-NonstatisticalInstruments	CMS-10197 AppendixC-NonstatisticalInstruments11_6_508ready.pdf		Yes	No	Fillable Fileable
Form and Instruction	CMS-10197	CMS-10197 AppendixD-InfConsentFormsScripts	CMS-10197 AppendixD-InfConsentFormsScripts11_6_508ready.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Master Demonstration, Evaluation and Research Studies for ORDI	FR Citation: 72 FR 19705

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	80	-11,920	12,000
Annual IC Time Burden (Hours)	120	-5,880	6,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.