Information Collection

Study Registry

IC 263505 under ICR 202311-0938-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10865 Study Registry	Form and Instruction
CMS-10865 Treatment of Alzheimer's Disease CED Study Registry Form Alzheimer's Disease Treatment - CED Study Registry Form Resources 7-6-23(508)_ (003).pdf	Form and Instruction
CMS-10865 Treatment of Alzheimer's Disease CED Study Registry Form Alzheimer's Disease Treatment - CED Study Registry Form Resources 7-6-23(508)_ (003).pdf	Form and Instruction

IC Title:

Study Registry

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

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-10865	Treatment of Alzheimer's Disease CED Study Registry Form	Alzheimer's Disease Treatment - CED Study Registry Form Resources 7-6-23(508)_ (003).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40,000	40,000
Annual IC Time Burden (Hours)	3,320	3,320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.