OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Partner Survey

IC 226367 under ICR 202301-0938-018 · OMB 0938-1342.

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

View Information Collection (IC)

Partner Survey
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10632 Appendix A - Partner Survey: Informed Consent and Survey CMS-10632.Appendix_A_Partner_Survey_srs_022221.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

60 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved 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 60 0 0 0 0 60
Annual IC Time Burden (Hours) 20 0 0 0 0 20
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Recruitment script CMS-10632.Appendix_C_Recruitment_Script_srs_022221.pdf 05/06/2021
Letter of Support CMS-10632.Appendix_D_Support_Letter_from_CMS_OMH_srs_012221LM.pdf 05/06/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.