OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Analysis of Transportation Barriers to Utilization of Medicare Services by American Indian and Alaska Native Medicare Beneficiaries

OMB 0938-1182 · HHS/CMS.

OMB 0938-1182

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10399 Appendix H1 and H2 HEALTH CARE PROVIDER RECRUITMENT LETTERS	Form and Instruction
Form CMS-10399 Appendix G CMS Consent Forms	Form and Instruction
Form CMS-10399 Appendix E Beneficiaries and Family Members Focus Group Protocol	Form and Instruction
Form CMS-10399 Appendix D Beneficiaries and Family Members Demographic Survey	Form and Instruction
Form CMS-10399 Appendix F Providers Interview Protocol	Form and Instruction
Form CMS-10399 Appendix C Beneficiary Interview Protocol	Form and Instruction
Form CMS-10399 Appendix A BENEFICIARY TBS	Form and Instruction
Form CMS-10399 Appendix B PROVIDERS TBS	Form and Instruction
CMS-10399 Supporting Statement Part B v5 CLEAN_rev10-15-12.pdf	Supporting Statement B
CMS Transportation Barriers Crosswalk.pdf	Supplementary Document
CMS-10399 Supporting Statement Part A v5 CLEAN_rev_10-15-12.pdf	Supporting Statement A
Survey	Form and Instruction
Survey	Form and Instruction
Survey	Form and Instruction
Survey	Form and Instruction
Survey	Form and Instruction
Survey	Form and Instruction
Survey	Form and Instruction
Survey	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201204-0938-005	New collection (Request for a new OMB Control Number)	2012-04-26		Approved with change