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Federal forms, ICRs, and supporting documents

Information Collection

Foundational Generative In-Depth Interviews for Identifying Needs and Challenges of Adult Caregivers' on Issues Related to Access, Technology, Privacy and Data sharing (CMS-10903)

IC 280485 under ICR 202609-0938-011 · OMB 0938-1382.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form CMS-10903
Generative In-Depth Interview Guide Foundational Generative In-Depth Interviews for Identifying Needs and Challenges of Adult Caregivers' on Issues Related to Access, Technology, Privacy and Data sharing (CMS-10903)		 Form and Instruction
Form CMS-10903
Caregiver Eligibility Screener Foundational Generative In-Depth Interviews for Identifying Needs and Challenges of Adult Caregivers' on Issues Related to Access, Technology, Privacy and Data sharing (CMS-10903)		 Form and Instruction
Form CMS-10903
Consent form Foundational Generative In-Depth Interviews for Identifying Needs and Challenges of Adult Caregivers' on Issues Related to Access, Technology, Privacy and Data sharing (CMS-10903)		 Form and Instruction
CMS-10903 Generative In-Depth Interview Guide
Attachment A - Generative In-Depth Interview Guide.docx 		Form and Instruction
CMS-10903 Caregiver Eligibility Screener
Attachment B - Caregiver Eligibility Screener.docx 		Form and Instruction
CMS-10903 Consent form
Attachment C - Consent form.docx 		Form and Instruction
CMS-10903_Supporting Statement A.docx
Gen-IC Supporting Statement		IC Document
PRA Disclosure Statement.docx
PRA Disclosure Statement		IC Document
Justification for Providing Incentives for Participation in Caregiver Research.docx
Justification for Providing Incentives for Participation		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-10903 No   Fillable Fileable
Form and Instruction CMS-10903 No   Fillable Fileable
Form and Instruction CMS-10903 No   Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested 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 1,220 0 0 0 0 1,220
Annual IC Time Burden (Hours) 220 0 0 0 0 220
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Gen-IC Supporting Statement 05/18/2026
PRA Disclosure Statement 05/18/2026
Justification for Providing Incentives for Participation 05/18/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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