Information Collection

In-person Discussions

IC 195445 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 In-person Discussions	Form and Instruction
CMS-10356 Discussion Guide CMS_Duals_DiscussionGuide_PRAReview_Final_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	Discussion Guide	CMS_Duals_DiscussionGuide_PRAReview_Final_1711 (clean).doc		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 320

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	320	320
Annual IC Time Burden (Hours)	480	480
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.