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Federal forms, ICRs, and supporting documents

Information Collection

IPRO ESRD Collaborator Satisfaction Survey (CMS-10750)

IC 257115 under ICR 202211-0938-011 · OMB 0938-1185.

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

View Information Collection (IC)

IPRO ESRD Collaborator Satisfaction Survey (CMS-10750)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10750 NW 1 Collaborator Survey CMS-10750 ESRD NW 1 Draft 2020 Collaborator Survey.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10750 NW 2 Collaborator Survey CMS-10750 ESRD NW 2 Draft 2020 Collaborator Survey.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10750 NW 6 Collaborator Survey CMS-10750 ESRD NW 6 Draft 2020 Collaborator Survey.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10750 NW 9 Collaborator Survey CMS-10750 ESRD NW 9 Draft 2020 Collaborator Survey.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

560 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 560 0 560 0 0 0
Annual IC Time Burden (Hours) 93 0 93 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10750 Generic_Clearance_Submission_IPRO ESRD.doc CMS-10750 Generic_Clearance_Submission_IPRO ESRD.doc.docx 11/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.