Information Collection

Consolidated Renal Operations in a Web Enabled Network (CROWNWeb) Third-party Submission Authorization Form (2nd and 3rd Years)

IC 186858 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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-10268 Consolidated Renal Operations in a Web Enabled Network (CROWNWeb) Third-party Submission Authorization Form (2nd and 3rd Years)	Form and Instruction
CMS-10268 CMS-10268.CROWNWeb Batch Data Submission Authorization F CROWNWeb Delegation of Authority Form _0 3_.pdf	Form and Instruction

IC Title:

Consolidated Renal Operations in a Web Enabled Network (CROWNWeb) Third-party Submission Authorization Form (2nd and 3rd Years)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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-10268	CMS-10268.CROWNWeb Batch Data Submission Authorization Form	CROWNWeb Delegation of Authority Form _0 3_.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,100

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
	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-2,100	2,100
Annual IC Time Burden (Hours)	-175	175
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.