Information Collection

Quantitative Data Collection

IC 207737 under ICR 201307-0938-004 · OMB 0938-1212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10467 Quantitative Data Collection	Form and Instruction
CMS-10467 Quantitative Data Collection Protocol QuantiProtocolCertified.pdf	Form and Instruction

IC Title:

Quantitative Data Collection

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-10467	Quantitative Data Collection Protocol	QuantiProtocolCertified.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

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	5	5
Annual IC Time Burden (Hours)	6,040	6,040
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.