Information Collection

Direct Service Workers - Survey on Core Competencies for the Direct Service Workforce

IC 210300 under ICR 201402-0938-003 · OMB 0938-1229.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1229 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10512 Direct Service Workers - Survey on Core Competencies for the Direct Service Workforce	Form and Instruction
CMS-10512 Survey on Core Competencies for the Direct Service Workf 3 DSW-CC-Survey-Instrument.pdf	Form and Instruction

IC Title:

Direct Service Workers - Survey on Core Competencies for the Direct Service Workforce

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
Form and Instruction	CMS-10512	Survey on Core Competencies for the Direct Service Workforce	3 DSW-CC-Survey-Instrument.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,400

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	1,200	1,200
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.