Information Collection

Consolidated Renal Operations in a Web Enabled Network (CROWNWeb) Batch Data Submission Form

IC 186857 under ICR 201308-0938-008 · OMB 0938-1052.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1052 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10268 Crosswalk.doc	Other-Crosswalk
CMS-10268 Crownweb Batch Data Submission Authorization form CROWNWeb Batch Data Submission Authorization Form 25April2013.pdf	Form and Instruction

IC Title:

Consolidated Renal Operations in a Web Enabled Network (CROWNWeb) Batch Data Submission Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Crosswalk			CMS-10268 Crosswalk.doc		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10268	Crownweb Batch Data Submission Authorization form	CROWNWeb Batch Data Submission Authorization Form 25April2013.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

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 Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	400	-2,600	3,000
Annual IC Time Burden (Hours)	34	-216	250
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.