OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Training

IC 205636 under ICR 202208-0938-022 · OMB 0938-1210.

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

View Information Collection (IC)

Training
 
No Removed
 
Required to Obtain or Retain Benefits
 
42 CFR 482 section 13

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10455 Health Death Report Form CMS-10455-AUG2017-Final. 02.06.2018.pdf Yes Yes Fillable Fileable
Instruction Instructions for completing CMS 10455 508 Aug 2017.pdf Yes Yes Fillable Fileable

Health Health Care Services

Automated Survey Processing Environment (ASPEN) Complaints/Incidents Tracking System (ACTS), System No. 09-70-1519  71 FR 29644

6,389 4,792
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   90 %

  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 0 0 -6,389 0 6,389 0
Annual IC Time Burden (Hours) 0 0 -6,389 0 6,389 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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