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Federal forms, ICRs, and supporting documents

Information Collection

Data Management Plan Self-Attestation Questionnaire (DMP SAQ)

IC 253071 under ICR 202505-0938-012 · OMB 0938-0734.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Data Management Plan Self-Attestation Questionnaire (DMP SAQ)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-R-235 Data Management Plans Self Attestation Questionnaire (DMP SAQ) DMP SAQ_5.1.docx Yes Yes Fillable Printable

Health Health Care Services

 

1,000 0
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,000 0 0 0 0 1,000
Annual IC Time Burden (Hours) 1,500 0 0 0 0 1,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change - DMP SAQ DMP-SAQ 5.1 REDLINE.pdf 05/23/2025
IT system - Data collection fields Form Fields .docx 05/29/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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