Information Collection

Public and Media Activity Report Form (PAM)

IC 193278 under ICR 201302-0938-008 · OMB 0938-0850.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10028 Public and Media Activity Report Form (PAM)	Form and Instruction
CMS-10028 Public and Media Activity Form (PAM) Public and Media Form Items Straight Text - For 508 Compliant Document - 09 Jan 2013.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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-10028	Public and Media Activity Form (PAM)	Public and Media Form Items Straight Text - For 508 Compliant Document - 09 Jan 2013.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,349

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	76,563	25,386	51,177
Annual IC Time Burden (Hours)	6,380	2,115	4,265
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.