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CMS-10731(GenIC#1). Was This Page Helpful Survey

IC 272113 under ICR 202304-0938-022 · OMB 0938-1459.

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

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CMS-10731(GenIC#1). Was This Page Helpful Survey
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10731. (GenIC#1) CMS-10731 (GenIC#1). Was This Page Helfpul Survey CMS-10731 (GenIC#1). Was This Page Helfpul Survey .docx Yes Yes Fillable Fileable

Health Health Care Services

 

2,000 0
   
Individuals or Households
 
   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 2,000 0 2,000 0 0 0
Annual IC Time Burden (Hours) 33 0 33 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10731 (GenIC#1). Fast Track Submission Request CMS-10731 (GenIC#1). Fast Track Submission Request.docx 11/04/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.