OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)

IC 257144 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
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10820 CMS-10820. CMS OBRHI_Clinician Focus Groups_Moderators Guide_Rev 20220803 CMS-10820. CMS OBRHI_Clinician Focus Groups_Moderators Guide_Rev 20220803.docx Yes No Printable Only
Form and Instruction CMS-10820 CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Rev 20221007.docx CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Rev 20221007.docx Yes No Printable Only

Health Health Care Services

 

148 0
   
Individuals or Households
 
   0 %

  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 148 0 148 0 0 0
Annual IC Time Burden (Hours) 73 0 73 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10820.CMS OBRHI_Clinician Focus Groups Supporting Statement_Rev 20221007 (1) CMS-10820.CMS OBRHI_Clinician Focus Groups_Supporting Statement_Rev 20221007 (1).docx 11/28/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.