Information Collection

Navigator Requirements for Training Certification

IC 251934 under ICR 202210-0938-013 · OMB 0938-1205.

Documents and Forms

Document Name Document Type
Form CMS-10494 Navigator Requirements for Training Certification Form and Instruction
CMS-10494 Post-Training Questionnaire CMS-10494 - Appendix F_MLMS Assister Post-Training Survey Questionnaire_508_2021.pdf Form and Instruction
CMS-10494 Post-Training Questionnaire CMS-10494 - Appendix F_MLMS Assister Post-Training Survey Questionnaire_508_2021.pdf Form and Instruction
CMS-10494 Training Completion Document CMS-10494 - Appendix E_CAC Training Completion Document_508_2021.pdf Form
CMS-10494 Training Completion Document CMS-10494 - Appendix E_CAC Training Completion Document_508_2021.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Navigator Requirements for Training Certification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10494	Post-Training Questionnaire	CMS-10494 - Appendix F_MLMS Assister Post-Training Survey Questionnaire_508_2021.pdf		Yes	Yes	Fillable Printable
Form	CMS-10494	Training Completion Document	CMS-10494 - Appendix E_CAC Training Completion Document_508_2021.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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: 95 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	60,977	60,977
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.