OMB control number
Evaluating Coverage to Care in Communities (CMS-10632)
OMB 0938-1342 · HHS/CMS.
OMB 0938-1342
The proposed evaluation is intended to achieve two separate but related goals. First, it will provide information that will support CMS OMH to maximize the impact of C2C at the local, state, and national levels. The evaluation will support selecting the best dissemination activities to maximize the spread of C2C, developing new messaging on preventive visits and primary care, and creating additional products to fill critical gaps. Second, findings from the evaluation will help CMS to assess whether and how C2C improves consumer health literacy and care utilization.
The latest form for Evaluating Coverage to Care in Communities (CMS-10632) expires 2020-09-30 and is listed under ICR 201704-0938-003.
Latest Forms, Documents, and Supporting Material
Form CMS-10632 Consumer Survey
Form CMS-10632 Partner Survey
CMS-10632_Non-sub_Change_Request_Memo 012623.docx
Consumer SurveyAll Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202301-0938-018 | No material or nonsubstantive change to a currently approved collection | 2023-02-02 | Approved without change | |
| 202105-0938-002 | Reinstatement with change of a previously approved collection | 2021-05-07 | Approved with change | |
| 201704-0938-003 | New collection (Request for a new OMB Control Number) | 2017-04-12 | Approved without change |
OMB Details
Organizational Survey
Federal Enterprise Architecture: Health - Health Care Services
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form CMS-10632 | Appendix A - Organization Survey: Informed Consent and Survey | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.