Information Collection

GenIC #13: Qualitative Research on Communications and Decision Support for Provider Initiatives

IC 269724 under ICR 202407-0938-019 · OMB 0938-1247.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10437. GenIC#1 GenIC #13: Qualitative Research on Communications and Decision Support for Provider Initiatives	Form and Instruction
CMS-10437. GenIC#1 CMS-10437. GenIC#13 - ProviderDecisionSupport_ModGuide_F CMS-10437. GenIC#13 - ProviderDecisionSupport_ModGuide_FINAL.docx	Form and Instruction
CMS-10437. GenIC#1 CMS-10437. GenIC#13 - ProviderDecisionSupport_ModGuide_F CMS-10437. GenIC#13 - ProviderDecisionSupport_ModGuide_FINAL.docx	Form and Instruction
CMS-10437.GenIC#13 - SupportingStatement_FINAL.docx CMS-10437.GenIC#13 - SupportingStatement_FINAL	IC Document
CMS-10437.GenIC#13 - SupportingStatement_FINAL.docx CMS-10437.GenIC#13 - SupportingStatement_FINAL	IC Document
CMS-10437.GenIC#13 Justification for Providing Incentives for Participation in Marketing Research.docx CMS-10437.GenIC#13 Justification for Providing Incentives for Participation in Marketing Research	IC Document
CMS-10437.GenIC#13 Justification for Providing Incentives for Participation in Marketing Research.docx CMS-10437.GenIC#13 Justification for Providing Incentives for Participation in Marketing Research	IC Document

IC Title:

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-10437. GenIC#13	CMS-10437. GenIC#13 - ProviderDecisionSupport_ModGuide_FINAL	CMS-10437. GenIC#13 - ProviderDecisionSupport_ModGuide_FINAL.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	900	900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10437.GenIC#13 - SupportingStatement_FINAL	CMS-10437.GenIC#13 - SupportingStatement_FINAL.docx	08/06/2024
CMS-10437.GenIC#13 Justification for Providing Incentives for Participation in Marketing Research	CMS-10437.GenIC#13 Justification for Providing Incentives for Participation in Marketing Research.docx	08/06/2024

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