Information Collection Request
End Stage Renal Disease (ESRD) Annual Home Dialysis within Nursing Home Survey Form (CMS-10842)
ICR 202406-0938-008 · OMB unassigned · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10842 J.10 Nursing Home Dialysis Survey |
Form and Instruction | New | Repair queued |
 CMS- 10842-Supporting Statement - Part A- clean.docx |
Supporting Statement A | Uploaded 2024-06-20 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 268792 |  J.10 Nursing Home Dialysis Survey |
Form and Instruction | New |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | CCSQ |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |