Certificate of Data Destruction for Data Acquired from the Centers for Medicare and Medicaid Services

Certificate of Data Destruction for Data Acquired from the Centers for Medicare and Medicaid Services

OMB: 0938-1046

IC ID: 184090

Information Collection (IC) Details

View Information Collection (IC)

Certificate of Data Destruction for Data Acquired from the Centers for Medicare and Medicaid Services
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10252 CMS-10252. Draft Revised DUA CMS-10252. Draft Revised DUA.pdf Yes No Fillable Fileable

Health Health Care Services

 

500 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   80 %

  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 500 0 0 0 0 500
Annual IC Time Burden (Hours) 84 0 0 0 0 84
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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