Information Collection

Chat/CCSQ Support Central – Basic information questions (CMS-10832)

IC 267557 under ICR 202405-0938-010 · OMB 0938-1397.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10832 Chat/CCSQ Support Central – Basic information questions (CMS-10832)	Form and Instruction
CMS-10832 Support Central screen shots CMS-10832 Support Central Screen shot.docx	Form and Instruction
CMS-10832 Support Central screen shots CMS-10832 Support Central Screen shot.docx	Form and Instruction
CMS-10832 Data Collection ICR 6.29.22.docx Supporting Statement	IC Document
CMS-10832 Data Collection ICR 6.29.22.docx Supporting Statement	IC Document

IC Title:

Chat/CCSQ Support Central â Basic information questions (CMS-10832)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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-10832	Support Central screen shots	CMS-10832 Support Central Screen shot.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,155

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

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	10,155	10,155
Annual IC Time Burden (Hours)	508	508
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	CMS-10832 Data Collection ICR 6.29.22.docx	05/09/2024

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