Information Collection

(CMS-10686) 2018 Resource Assessment

IC 233653 under ICR 201611-0938-004 · OMB 0938-1185.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10686 (CMS-10686) 2018 Resource Assessment	Form and Instruction
CMS-10686 Resource Assessment CMS-10686 Resource Assessment_100518.pdf	Form and Instruction
CMS-10686 Generic_Clearance_Submission_ResourceAssessment2018 (1).pdf CMS-10686 Supporting Statement	IC Document

IC Title:

(CMS-10686) 2018 Resource Assessment

Agency IC Tracking Number:

IC Status: New

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-10686	Resource Assessment	CMS-10686 Resource Assessment_100518.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,682

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,682	9,682
Annual IC Time Burden (Hours)	808	808
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10686 Supporting Statement	CMS-10686 Generic_Clearance_Submission_ResourceAssessment2018 (1).pdf	10/19/2018

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