Information Collection

Pre-site Discussions

IC 195444 under ICR 201011-0938-014 · OMB 0938-1120.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10356 Pre-site Discussions	Form and Instruction
CMS-10356 Pre-site Protocol CMS_Duals_PreSite_HRR_Protocol_PRAReview_1711(clean).doc	Form and Instruction

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-10356	Pre-site Protocol	CMS_Duals_PreSite_HRR_Protocol_PRAReview_1711(clean).doc		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.