Information Collection

GenIC #44 - Oral Health Initiative, Customer Satisfaction Survey Tool

IC 218238 under ICR 201410-0938-016 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10398 (#44) GenIC #44 - Oral Health Initiative, Customer Satisfaction Survey Tool	Form and Instruction
CMS-10398 (#44) Customer Satisfaction Evaluation of Form CMS-416 Web-Bas 44 - CMS-416 Curriculum Evaluation [rev 09-17-2015 by OSORA PRA] -- CLEAN.docx	Form and Instruction
44 - Supporting Statement Oral Health Initiative Tool [rev 09-17-2015 by OSORA PRA] -- CLEAN.docx Supporting Statement	IC Document

IC Title:

GenIC #44 - Oral Health Initiative, Customer Satisfaction Survey Tool

Agency IC Tracking Number:

IC Status: New

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 and Instruction	CMS-10398 (#44)	Customer Satisfaction Evaluation of Form CMS-416 Web-Based Training Modules	44 - CMS-416 Curriculum Evaluation [rev 09-17-2015 by OSORA PRA] -- CLEAN.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	44 - Supporting Statement Oral Health Initiative Tool [rev 09-17-2015 by OSORA PRA] -- CLEAN.docx	09/18/2015

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