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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form CMS-10467 Quantitative Data Collection Form and Instruction
CMS-10467 Quantitative Data Collection Protocol QuantiProtocolCertified.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.