Information Collection Request
Value in Opioid Use Disorder Treatment Demonstration (CMS-10728)
ICR 202305-0938-016 · OMB 0938-1388 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10728 Participation Agreement |
Form and Instruction | Removed | Repair queued |
| Form CMS-10728 Participant Survey |
Form and Instruction | Modified | Repair queued |
| Form CMS-10728 Beneficiary Survey |
Form and Instruction | Modified | Repair queued |
| Form CMS-10728 Beneficiary Notification |
Form and Instruction | Modified | Repair queued |
| Form CMS-10728 Request for Application |
Form and Instruction | Modified | Repair queued |
 CMS-10728_OUD_Supporting Statement - Part A.docx |
Supporting Statement A | Uploaded 2023-05-31 | Repair queued |
 Value in Treatment 2022 Amendment No. 1 Sequestration (003).pdf |
Supplementary Document | Uploaded 2023-05-31 | Repair queued |
 ViT RFA Attachment 2 prevalence rates.xlsx |
Supplementary Document | Uploaded 2020-12-03 | Repair queued |
| ViT_OUD_Diagnosis_Codes.pdf |
Supplementary Document | Uploaded 2023-05-31 | Missing upstream |
| ViT PA Final clean 3.25.2021.pdf |
Supplementary Document | Uploaded 2023-05-31 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 244606 |  Participation Agreement |
Form and Instruction | Removed | |
| 242941 | Participant Financial |
Instruction | Modified | |
| 242940 | Participant Compliance Audit |
Instruction | Modified | |
| 242939 | Participant Survey |
Form and Instruction | Modified | |
| 242934 | Beneficiary Survey |
Form and Instruction | Modified | |
| 242933 | Beneficiary Notification |
Form and Instruction | Modified | |
| 242932 | Request for Application |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1388 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202007-0938-012 |
| Agency Tracking No | CMMI |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |