Initial and Terminal Administration of the Survey

Community Based Care Transitions Program (CCTP) Implementation and Monitoring

OMB: 0938-1167

IC ID: 199899

Information Collection (IC) Details

View Information Collection (IC)

Initial and Terminal Administration of the Survey
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10403 CCTP -Spanish Version Appendix B CCTP items in Spanish.docx No No Paper Only
Form and Instruction CMS-10403 CCTP_2nd_Admin_Participant_Exp_Survey CCTP_2nd_Admin_Participant_Exp_Survey_Draft_(3-12-12_glui)_Pilot_Test.docx No No Paper Only
Form and Instruction CMS-10433 Appendix C_CCTP 1st Admin Participant Exp Survey Appendix C_CCTP 1st Admin Participant Exp Survey_Clean Version_Final.pdf No No Paper Only

Health Health Care Services

 

216,000 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 432,000 0 0 0 0 432,000
Annual IC Time Burden (Hours) 54,000 0 0 0 0 54,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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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