Information Collection

Practitioners, PMD Suppliers, and Advocates

IC 209055 under ICR 201310-0938-007 · OMB 0938-1235.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1235 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10471.Background Research Discussion Guide.docx	Instruction
CMS-10471 PMD Stakeholders Screening and Scheduling Guide CMS-10471.PMD Stakeholders Screening and Scheduling Guide .docx	Form and Instruction
CMS-10471.Qualitative Research Protocols - Advocates.docx CMS-10471	IC Document
CMS-10471.Qualitive Research Protocols-Practitioners.docx CMS-10471	IC Document

IC Title:

Practitioners, PMD Suppliers, and Advocates

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
Instruction			CMS-10471.Background Research Discussion Guide.docx		Yes	No	Fillable Fileable
Form and Instruction	CMS-10471	PMD Stakeholders Screening and Scheduling Guide	CMS-10471.PMD Stakeholders Screening and Scheduling Guide .docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 254

Number of Respondents for Small Entity: 96

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	254	254
Annual IC Time Burden (Hours)	288	288
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10471	CMS-10471.Qualitative Research Protocols - Advocates.docx	10/23/2013
CMS-10471	CMS-10471.Qualitive Research Protocols-Practitioners.docx	10/23/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.