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

Document Name Document Type
Form CMS-10462 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

View Information Collection (IC)

IC Title:	Discussion Protocols for Beneficiary Focus Group and Stakeholder Focus Group	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	CMS-10462	Discussion Protocol for Beneficiary Focus Group	CFC Beneficiary Discussion Protocol [rev 3-27-2014 by OSORA PRA].docx		No	No	Fillable Printable
Form	CMS-10462	Discussion Protocol for Stakeholder Focus Group	CFC Stakeholder Discussion Protocol [rev 3-27-2014 by OSORA PRA].docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.