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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.