Information Collection

RCHD Evaluation Interview Protocols and Annual Progress Report Tool -- private hospitals

IC 210347 under ICR 201402-0938-009 · OMB 0938-1253.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10508 Data Collection Protocols RCHD Evaluation Interview Protocols and Annual Progress Report Tool -- private hospitals	Form and Instruction
CMS-10508 Data Collection Protocols RCHD_OMB_protocols_7Nov2013.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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-10508				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 8

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 64 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	23	23
Annual IC Time Burden (Hours)	168	168
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.

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