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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	(CMS-10686) 2018 Resource Assessment	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-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 %

	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

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.