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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.