Information Collection

Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)

IC 256602 under ICR 201904-0938-017 · 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⚠️ Notice: This information collection may be referencing outdated material.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-10820 CMS OBRHI_Clinician Focus Groups_Moderators Guide_Rev 20220803 Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)	Form and Instruction
Form CMS-10820 CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Rev 20221007 Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)	Form and Instruction
CMS-10820 CMS OBRHI_Clinician Focus Groups_Moderators Guide_Rev 20 CMS-10820. CMS OBRHI_Clinician Focus Groups_Moderators Guide_Rev 20220803.docx	Form and Instruction
CMS-10820 CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Re CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Rev 20221007.docx	Form and Instruction
CMS-10820.CMS OBRHI_Clinician Focus Groups_Supporting Statement_Rev 20221007.docx CMS-10820.CMS OBRHI_Clinician Focus Groups_Supporting Statement_Rev 20221007	IC Document

IC Title:

Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)

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-10820				Yes	No	Printable Only
Form and Instruction	CMS-10820				Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 148

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	148	148
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10820.CMS OBRHI_Clinician Focus Groups_Supporting Statement_Rev 20221007		10/25/2022

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

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