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Federal forms, ICRs, and supporting documents

Information Collection

IPRO Community of Care Coalitions Collaborator Survey (CMS-10771)

IC 257136 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 Community of Care Coalitions Collaborator Survey (CMS-10771)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10771 IPRO Collaborator - Community of Care Coalitions Survey CMS-10771 2022 IPRO Collaborator - Community of Care Coalitions.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

50 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 50 0 50 0 0 0
Annual IC Time Burden (Hours) 8 0 8 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10771 Generic_Clearance_Submission_IPRO - Community of Care Coalitions V2 CMS-10771 Generic_Clearance_Submission_IPRO - Community of Care Coalitions V2.docx 11/28/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.