Information Collection

Training Registration

IC 216289 under ICR 201504-0938-014 · OMB 0938-1220.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10472 Training Registration	Form and Instruction
CMS-10472 Training Quality Questionnaire Appendix F_Training Quality Questionnaire.pdf	Form and Instruction
CMS-10472 Sample Training Completion Certificate Appendix B_ SampleTraining Completion Certificate.pdf	Form and Instruction
CMS-10472 Registration Portal Appendix A_Registration Portal.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.215

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10472	Training Quality Questionnaire	Appendix F_Training Quality Questionnaire.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10472	Sample Training Completion Certificate	Appendix B_ SampleTraining Completion Certificate.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10472	Registration Portal	Appendix A_Registration Portal.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,510

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,510	3,510
Annual IC Time Burden (Hours)	1,327	1,327
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.