Screening

Survey to Inform the Children's Health Insurance Program (CHIP) National Outreach & Education Campaign

OMB: 0938-1112

IC ID: 194460

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Screening
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10318 CHIP Survey CMS-10318. CHIP Survey FINAL-508COMPL.pdf Yes No Fillable Fileable
Form and Instruction CMS-10318 CMS Chip Medicaid Survey Final 10_19_10 CMS Chip Medicaid Survey.pdf Yes No Fillable Fileable

Health Health Care Services

 

3,700 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 3,700 3,700 0 0 0 0
Annual IC Time Burden (Hours) 308 308 0 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.

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