Site Visit Interviews

Medicaid Incentives for Prevention of Chronic Diseases Evaluation

OMB: 0938-1219

IC ID: 208110

Information Collection (IC) Details

View Information Collection (IC)

Site Visit Interviews
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10477 Management staff interview protocol and consent Attachment_5c_SV_Management_Protocol_Consent_Form.pdf No No Fillable Fileable
Form and Instruction CMS-10477 Recruitment staff interview protocol and consent Attachment_5d_SV_Recruiter_Protocol_Consent_Form.pdf No No Fillable Fileable
Form and Instruction CMS-10477 Staff educator interview protocol and consent Attachment_5e_SV Educator_Protocol_Consent_Forms.pdf No No Fillable Fileable
Form and Instruction CMS-10477 State evaluator interview protocol and consent Attachment_5f_SV_Evaluator_Protocol_Consent Form.pdf No No Fillable Fileable
Form and Instruction CMS-10477 Clinic staff interview protocol and consent Attachment_5g_SV Clinic_Protocol_Consent_Forms.pdf No No Fillable Fileable

Health Health Care Services

 

200 10
   
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 200 200 0 0 0 0
Annual IC Time Burden (Hours) 200 200 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Site Visit Frequently Asked Questions Attachment_5a_Background_FAQ.pdf 08/06/2013
Site visit interview invitation Attachment_5b_Interview_Email_Invitation.pdf 08/06/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy