(CMS-10685) E-mail Feedback Regarding Psychiatric Facility Quality Measure Strategies

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1185 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10685 (CMS-10685) E-mail Feedback Regarding Psychiatric Facility Quality Measure Strategies Form and Instruction
CMS-10685 LAN member best practices email D1 LAN Member Best Practices Email.docx Form and Instruction
CMS-10685 Generic_Clearance_Submission_Template_D1V_IPF_Measure_Feedback.doc CMS-10685 GenIC Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	(CMS-10685) E-mail Feedback Regarding Psychiatric Facility Quality Measure Strategies	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10685	LAN member best practices email	D1 LAN Member Best Practices Email.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 179	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	179	179
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10685 GenIC Supporting Statement	CMS-10685 Generic_Clearance_Submission_Template_D1V_IPF_Measure_Feedback.doc	10/04/2018

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