Information Collection

GenIC IC #2 - Cognitive Testing for Questions LGBT

IC 217196 under ICR 201508-0938-002 · OMB 0938-1275.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1275 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10549 (GenIc#2 GenIC IC #2 - Cognitive Testing for Questions LGBT	Form and Instruction
CMS-10549 (GenIc#2 Cognitive Testing for LGBT Questions 0938-1275 (GenIC#2) - Attachments A-H.docx	Form and Instruction
0938-1275 (CMS-10549) - GenIC#2 -MCBS Cognitive Testing LGBT Items 10 day letter.docx 0938-1275 (CMS-10549) - GenIC#2 -MCBS Cognitive Testing LGBT Items 10 day letter	IC Document

IC Title:

GenIC IC #2 - Cognitive Testing for Questions LGBT

Agency IC Tracking Number:

IC Status: Modified

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-10549 (GenIc#2)	Cognitive Testing for LGBT Questions	0938-1275 (GenIC#2) - Attachments A-H.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	55	55
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0938-1275 (CMS-10549) - GenIC#2 -MCBS Cognitive Testing LGBT Items 10 day letter	0938-1275 (CMS-10549) - GenIC#2 -MCBS Cognitive Testing LGBT Items 10 day letter.docx	08/03/2015

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