OMB
.report
Search
Beneficiary Notification
Value in Opioid Use Disorder Treatment Demonstration (CMS-10728)
OMB: 0938-1388
IC ID: 242933
OMB.report
HHS/CMS
OMB 0938-1388
ICR 202007-0938-012
IC 242933
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1388 can be found here:
2023-05-31 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10728
Beneficiary Notification
Form and Instruction
CMS-10728 Beneficiary Notification
Value in Treatment_OUD Medicare Beneficiary Notice_Final.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Beneficiary Notification
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR 1866F (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10728
Beneficiary Notification
Value in Treatment_OUD Medicare Beneficiary Notice_Final.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
Master Demonstration, Evaluation, and Research Studies for the Office of Research Development and Information (DERS)
FR Citation:
83 FR 6591
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
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
100
100
0
0
0
0
Annual IC Time Burden (Hours)
50
50
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.