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Federal forms, ICRs, and supporting documents

Information Collection

End Stage Renal Disease Grievant Satisfaction Survey

IC 257105 under ICR 202211-0938-011 · OMB 0938-1185.

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

View Information Collection (IC)

End Stage Renal Disease Grievant Satisfaction Survey
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10415. GenIC#5 End Stage Renal Disease (ESRD) Grievant Satisfaction Survey ESRD Grievant Satisfaction Survey.docx Yes No Fillable Fileable

Health Health Care Services

 

384 0
   
Individuals or Households
 
   0 %

  Requested 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 384 0 384 0 0 0
Annual IC Time Burden (Hours) 77 0 77 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Clearance Submission Template ESRD Grievant Satisfaction Survey Generic Clearance Submission Template_ESRD Grievant Satisfaction Survey.docx 11/25/2022
Pre-Notification Letter Version 2.0 Pre-Notification Letter_Version 2.0.docx 11/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.