Information Collection Request

Evaluation of the Graduate Nurse Education Demonstration Program (CMS-10467)

ICR 201601-0938-003 · OMB 0938-1212 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10467 Quantitative Data Collection Protocol Form and Instruction Removed Available
Form CMS-10467 Verbal Consent Statement Form and Instruction Modified Available
Form CMS-10467 Qualitative Data Collection Protocols Form and Instruction Modified Available
Form CMS-10467 Attachment 2: Qualitative Data Collection Protocol Form and Instruction Modified Available
2nd Passback CMS-10467 Evaluation of GNE Demo Supporting Statement B_CLEAN_TO CMS.docx Supporting Statement B Uploaded 2016-09-06 Available
CMS Response to Public Comments 01_11_16.docx Supplementary Document Uploaded 2016-01-21 Available
2nd Passback CMS-10467 Evaluation of GNE Demo Supporting Statement A_CLEAN_TO CMS.docx Supporting Statement A Uploaded 2016-09-06 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
207737 Quantitative Data Collection Form and Instruction RemovedQuantitative Data Collection Protocol
207736 Data Collection Form and Instruction ModifiedVerbal Consent Statement
207736 Data Collection Form and Instruction ModifiedQualitative Data Collection Protocols
207736 Data Collection Form and Instruction ModifiedAttachment 2: Qualitative Data Collection Protocol

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2019 36 Months From Approved 10/31/2016
104 0 595
802 0 6,740
0 0 0





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1
table that charts list of burden
IC Title Form No. Form Name
Data Collection CMS-10467, CMS-10467, CMS-10467 ,   ,  
Quantitative Data Collection CMS-10467

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 104 595 0 -491 0 0
Annual Time Burden (Hours) 802 6,740 0 -5,938 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No