Information Collection

EDPEC Discharged to Community

IC 215083 under ICR 201502-0938-005 · OMB 0938-1273.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10543 EDPEC Survey Telephone Script EDPEC Discharged to Community	Form and Instruction
Form CMS-10543 EDPEC Discharged to Community EDPEC Discharged to Community	Form
Attachment8-DischargedToCommunity-MixedLtr.pdf	Other-Letter (Mailed)
Attachment9-DischargedToCommunity-OnsiteLtr.pdf	Other-Letter (On-site Distribution)
CMS-10543 EDPEC Survey Telephone Script Attachment7-EDPEC PHONE SCRIPTS-ALL VERSIONS.pdf	Form and Instruction
CMS-10543 EDPEC Discharged to Community Attachment4-EDPEC_Discharged to Community.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Other-Letter (Mailed)		No	Paper Only
Other-Letter (On-site Distribution)		No	Paper Only
Form and Instruction	CMS-10543	No	Fillable Printable
Form	CMS-10543	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 576

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	576	576
Annual IC Time Burden (Hours)	103	103
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].