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Federal forms, ICRs, and supporting documents

Information Collection

Discussion Protocols for Beneficiary Focus Group and Stakeholder Focus Group

IC 211014 under ICR 201403-0938-017 · OMB 0938-1238.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form CMS-10462
Discussion Protocol for Beneficiary Focus Group Discussion Protocols for Beneficiary Focus Group and Stakeholder Focus Group		 Form
Form CMS-10462
Discussion Protocol for Stakeholder Focus Group Discussion Protocols for Beneficiary Focus Group and Stakeholder Focus Group		 Form
CMS-10462 Discussion Protocol for Beneficiary Focus Group
CFC Beneficiary Discussion Protocol [rev 3-27-2014 by OSORA PRA].docx 		Form
CMS-10462 Discussion Protocol for Stakeholder Focus Group
CFC Stakeholder Discussion Protocol [rev 3-27-2014 by OSORA PRA].docx 		Form

Information Collection (IC) Details

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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 CMS-10462 No No Fillable Printable
Form CMS-10462 Yes Yes Fillable Printable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 40 40 0 0 0 0
Annual IC Time Burden (Hours) 60 60 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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