OMB control number
Prospective Evaluation of Evidence-Based Community Wellness and Prevention Programs (CMS-10509)
OMB 0938-1252 · HHS/CMS.
OMB 0938-1252
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10509 Program Participants Survey | Form and Instruction |
| Form CMS-10509 National Readiness Survey | Form and Instruction |
 RTC_CommunityBasedWellnessPrograms.pdf | Supplementary Document |
| 8926 04 13 12 13 Expedited approval of CMS Wellness Eval.pdf | Supplementary Document |
| OMB_Draft_Wellness_Eval_Part_B_Attachment_1_Sources_of_Survey_Items_03112014.pdf | Supplementary Document |
| OMB_Wellness_Eval_Part_B_09052014_clean.docx | Supporting Statement B |
| OMB_Wellness_Eval_Part_A_09052014_clean.docx | Supporting Statement A |
 Program Participants Survey |
Form and Instruction |
| National Readiness Survey |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201404-0938-008 | New collection (Request for a new OMB Control Number) | 2014-04-28 | Approved with change |