Information Collection

Navigator Requirements for Training Certification

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

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-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 %

table that charts list of burden
	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

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.