Information Collection

Medicare Gainsharing Demonstration Evaluation: Physician Focus Groups (CMS-10303)

IC 192883 under ICR 201107-0938-002 · OMB 0938-1103.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10303 Advance Letters and Focus Group Discussion Protocols Medicare Gainsharing Demonstration Evaluation: Physician Focus Groups (CMS-10303)	Form and Instruction
CMS-10303 Advance Letters and Focus Group Discussion Protocols CMS-10303.Attachments C and D.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-10303				No	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 288

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	288	211	77
Annual IC Time Burden (Hours)	288	211	77
Annual IC Cost Burden (Dollars)	0	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.

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