Search and Review

The Predictive Learning Analytics Tracking Outcome (PLATO™) - (CMS-10517)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1262 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10517 Search and Review Form and Instruction
CMS-10517 The Predictive Learning Analytics Tracking Outcome (PLAT CMS-10517_PLATO_Screen_Shots.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Search and Review	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	CMS-10517	The Predictive Learning Analytics Tracking Outcome (PLATO)	CMS-10517_PLATO_Screen_Shots.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,550	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	1,550	1,550
Annual IC Time Burden (Hours)	18,600	18,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.