Information Collection

Self-Advocates and Guardians - Survey on Core Competencies for the Direct Service Workforce

IC 210302 under ICR 201405-0938-001 · OMB 0938-1229.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10512 Self-Advocates and Guardians - Survey on Core Competencies for the Direct Service Workforce	Form
CMS-10512 Survey on Core Competencies for the Direct Service Workf DSW CC Revised Survey Screenshots OMB Control 0938-1229.docx	Form
Crosswalk.docx Crosswalk	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	CMS-10512	Survey on Core Competencies for the Direct Service Workforce	DSW CC Revised Survey Screenshots OMB Control 0938-1229.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	Crosswalk.docx	05/08/2014

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