OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Part A Providers Web-Based Survey

IC 243671 under ICR 202009-0938-010 · OMB 0938-1348.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Part A Providers Web-Based Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10633 Web Based Surveys QDEC-Attachment A-WebBasedSurvey_508compliant.pdf Yes Yes Fillable Fileable
Form CMS-10633 Part A Survey Screenshots QDEC_Attachment E Part A survey screenshots.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

2,544 1,524
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 2,544 0 0 2,544 0 0
Annual IC Time Burden (Hours) 425 0 0 425 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
QDEC_Attachment A Web Based Survey_508 Compliant.pdf 06/27/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.