Information Collection

RADV Training Information Collection

IC 248050 under ICR 202105-0938-011 · OMB 0938-1400.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10764 RADV Training Information Collection	Form and Instruction
CMS-10764 Appendix A - RADV Instrument CMS_10764_AppendixA_RADV_Instrument_5CR_102120.pdf	Form and Instruction
CMS-10764 Appendix A - RADV Instrument CMS_10764_AppendixA_RADV_Instrument_5CR_102120.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

CPI -10764

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 422.310(e)

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-10764	Appendix A - RADV Instrument	CMS_10764_AppendixA_RADV_Instrument_5CR_102120.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,270

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	4,270	4,270
Annual IC Time Burden (Hours)	1,068	1,068
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.