Participant Survey

Value in Opioid Use Disorder Treatment Demonstration (CMS-10728)

OMB: 0938-1388

IC ID: 242939

Documents and Forms
Information Collection (IC) Details

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Participant Survey
 
No New
 
Voluntary
 
42 CFR 1866F  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10728 Participant Survey PRA-OUD Demo-Participant Survey (v3)-Clean.docx Yes Yes Fillable Printable

Health Health Care Services

Master Demonstration, Evaluation, and Research Studies for the Office of Research Development and Information (DERS)  83 FR 6591

100 0
   
Private Sector Businesses or other for-profits
 
   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) 200 200 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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