Information Collection

Replacing Durable Medical Equipment and Prescription Drugs after a Disaster Addressing the Needs of Medicare Beneficiaries Post-training Feedback Survey (CMS-10828)

IC 257143 under ICR 202211-0938-011 · OMB 0938-1185.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10828 Replacing Durable Medical Equipment and Prescription Drugs after a Disaster Addressing the Needs of Medicare Beneficiaries Post-training Feedback Survey (CMS-10828)	Form and Instruction
Form CMS-10828 Post-Webinar Feedback Survey Replacing Durable Medical Equipment and Prescription Drugs after a Disaster Addressing the Needs of Medicare Beneficiaries Post-training Feedback Survey (CMS-10828)	Form and Instruction
CMS-10828 Post-Webinar Feedback Survey CMS-10828 Post-webinar Evaluation SurveyGoogle Forms_092822.pdf	Form and Instruction
CMS-10828 Post-Webinar Feedback Survey CMS-10828 Post-webinar Evaluation SurveyGoogle Forms_092822.pdf	Form and Instruction
CMS-10828 MEMO_ Fasttrack Generic Clearance Submission.docx CMS-10828 MEMO_ Fasttrack Generic Clearance Submission	IC Document
CMS-10828 MEMO_ Fasttrack Generic Clearance Submission.docx CMS-10828 MEMO_ Fasttrack Generic Clearance Submission	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Replacing Durable Medical Equipment and Prescription Drugs after a Disaster Addressing the Needs of Medicare Beneficiaries Post-training Feedback Survey (CMS-10828)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10828	Post-Webinar Feedback Survey	CMS-10828 Post-webinar Evaluation SurveyGoogle Forms_092822.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10828 MEMO_ Fasttrack Generic Clearance Submission	CMS-10828 MEMO_ Fasttrack Generic Clearance Submission.docx	11/28/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.