OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

HCBS Incident Management Survey

IC 235360 under ICR 202206-0938-024 · OMB 0938-1362.

Documents and Forms
Document Name
Document Type
Other-Introductory Email
Other-Introductory Email
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

HCBS Incident Management Survey
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Introductory Email CMS-10692. Introductory- Email-for-IM Survey.pdf Yes No Printable Only
Form and Instruction CMS-10692 CIM Survey Final.pdf CMS-10698. CIM Survey Final.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

51 0
   
State, Local, and Tribal Governments
 
   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 102 0 0 0 0 102
Annual IC Time Burden (Hours) 153 0 0 0 0 153
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.