Information Collection

CRCHD Mentored Mock Review – Participant Feedback (NCI)

IC 254128 under ICR 202002-0925-002 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 MMR 2022 survey CRCHD Mentored Mock Review – Participant Feedback (NCI)	Form
1 MMR 2022 survey MMR 2022 Survey Screenshots.pdf	Form
Fast Track - Customer Feedback Submission - MMR 2022.docx fast track for 2022 MMR feedback	IC Document
2022 MMR Email Invite.docx email invite	IC Document

IC Title:

CRCHD Mentored Mock Review â Participant Feedback (NCI)

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	200	200
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
fast track for 2022 MMR feedback		06/08/2022
email invite		06/08/2022

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

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