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Federal forms, ICRs, and supporting documents

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IPRO Collaborator Satisfaction Survey-Request for Approval-Nursing Homes (CMS-10776)

IC 257125 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
Information Collection (IC) Details

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IPRO Collaborator Satisfaction Survey-Request for Approval-Nursing Homes (CMS-10776)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10776 Collaborator Survey Nursing Home CMS-10776 Draft_2021 Collaborator Survey_Nursing Home_03.22.21 (1).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

964 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 964 0 964 0 0 0
Annual IC Time Burden (Hours) 161 0 161 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10776 Generic_Clearance_Submission_IPRO - Nursing Home CMS-10776 Generic_Clearance_Submission_IPRO - Nursing Home.docx 11/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.