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Federal forms, ICRs, and supporting documents

Information Collection

User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) (CMS-10754)

IC 257134 under ICR 202211-0938-011 · OMB 0938-1185.

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

View Information Collection (IC)

User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) (CMS-10754)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10754 GADCS Feedback Application GADCS Draft Feedback Clean.docx Yes Yes Fillable Fileable
Instruction GADCS User Guide Clean.docx Yes No Printable Only

Health Health Care Services

 

80 0
   
Private Sector 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 80 0 80 0 0 0
Annual IC Time Burden (Hours) 160 0 160 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
UAT Recruitment email UAT Recruitment email.docx 11/28/2022
CMS-10754 - Fast Track Supporting Statement CMS-10754 - Fast Track Supporting Statement.docx 11/28/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.