RCHD Hospital Interview Protocols and Annual Progress Report Template -- public hospitals

Evaluation of the Rural Community Hospital Demonstration

Documents and Forms

Document Name Document Type
Form CMS-10508 RCHD Hospital Interview Protocols and Annual Progress Report Template -- public hospitals Form and Instruction
CMS-10508 Data Collection Protocols RCHD_OMB_protocols_7Nov2013.docx Form and Instruction

Information Collection (IC) Details

IC Title:	RCHD Hospital Interview Protocols and Annual Progress Report Template -- public hospitals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

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-10508	Data Collection Protocols	RCHD_OMB_protocols_7Nov2013.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7	Number of Respondents for Small Entity: 7

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 68 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	77	77
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.