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

Documents and forms in this information collection
Document NameDocument Type
Form CMS-10820
Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)		 Form and Instruction
Form CMS-10820
CMS-10820. CMS OBRHI_Clinician Focus Groups_Moderators Guide_Rev 20220803 Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)		 Form and Instruction
Form CMS-10820
CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Rev 20221007.docx Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)		 Form and Instruction
CMS-10820 CMS-10820. CMS OBRHI_Clinician Focus Groups_Moderators G
CMS-10820. CMS OBRHI_Clinician Focus Groups_Moderators Guide_Rev 20220803.docx 		Form and Instruction
CMS-10820 CMS-10820. CMS OBRHI_Clinician Focus Groups_Moderators G
CMS-10820. CMS OBRHI_Clinician Focus Groups_Moderators Guide_Rev 20220803.docx 		Form and Instruction
CMS-10820 CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Re
CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Rev 20221007.docx 		Form and Instruction
CMS-10820 CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Re
CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Rev 20221007.docx 		Form and Instruction
CMS-10820.CMS OBRHI_Clinician Focus Groups_Supporting Statement_Rev 20221007 (1).docx
CMS-10820.CMS OBRHI_Clinician Focus Groups Supporting Statement_Rev 20221007 (1)		IC Document
CMS-10820.CMS OBRHI_Clinician Focus Groups_Supporting Statement_Rev 20221007 (1).docx
CMS-10820.CMS OBRHI_Clinician Focus Groups Supporting Statement_Rev 20221007 (1)		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-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

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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

Documents for IC
table that charts IC Documents
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.