Cognitive Testing for the Marketplace Dental Survey (CMS-10591)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415)

OMB: 0938-1185

IC ID: 219435

Information Collection (IC) Details

View Information Collection (IC)

Cognitive Testing for the Marketplace Dental Survey (CMS-10591)
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10591 Marketplace Dental Survey Cognitive Testing Eligibility Screener Combined MDS OMB Submission Items Clean 111615.doc No   Paper Only

Health Health Care Services

 

48 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 48 0 0 0 0 48
Annual IC Time Burden (Hours) 48 0 0 0 0 48
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Clearance Submission Form_MDS Cognitive Testing Generic Clearance Submission Form_MDS Cognitive Testing_10-29-15.doc 12/29/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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