Functional Assessment Standardized Items (FASI): Round 2

Testing Experience and Functional Tools: Functional Assessment Standardized Items (FASI) Based on the CARE Tool (CMS-10243)

OMB: 0938-1037

IC ID: 222998

Information Collection (IC) Details

View Information Collection (IC)

Functional Assessment Standardized Items (FASI): Round 2
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10243 Functional Assessment Standardized Items (FASI) TEFT072116FASIItems508 [rev 08-12-2016 by OSORA PRA].pdf No   Fillable Printable

Health Health Care Services

 

4,080 0
   
Individuals or Households
 
   0 %

  Approved 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 4,080 0 4,080 0 0 0
Annual IC Time Burden (Hours) 2,040 0 2,040 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk ChangeCrosswalk072116Final508.pdf 08/12/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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