Information Collection

QIC Demonstration Evaluation Contractor (QDEC): Key Informant Interviews

IC 227304 under ICR 201706-0938-005 · OMB 0938-1348.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1348 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10633 QIC Demonstration Evaluation Contractor (QDEC): Key Informant Interviews	Form and Instruction
CMS-10633 Key Informant Interviews QDEC_Attachment B Key Informant Interviews _Revised for Passback.docx	Form and Instruction

IC Title:

QIC Demonstration Evaluation Contractor (QDEC): Key Informant Interviews

Agency IC Tracking Number:

Is this a Common Form? No

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-10633	Key Informant Interviews	QDEC_Attachment B Key Informant Interviews _Revised for Passback.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 15

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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