Organizational Survey

Evaluating Coverage to Care (C2C) (CMS-10632)

OMB: 0938-1342

IC ID: 226367

Information Collection (IC) Details

View Information Collection (IC)

Organizational Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10632 Appendix A - Organization Survey: Informed Consent and Survey CMS-10632.Appendix A - Organizational Survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

600 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 600 0 600 0 0 0
Annual IC Time Burden (Hours) 198 0 198 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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