View Information Collection (IC)

View Information Collection (IC)

Data Use Agreement Information Collection Requirements, Model Language, and Supporting Regulations in 45 CFR Section 5b
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-R-235 CMS-R-235.Tab_2c CMS-R-235.Tab_2c_Draft.pdf Yes No Fillable Fileable
Form and Instruction CMS-R-235 CMS-R-235.Tab_2a CMS-R-235.Tab_2a_Draft.pdf Yes No Fillable Fileable
Form and Instruction CMS-R-235 CMS-R-235.Tab_2b CMS-R-235.Tab_2b_Draft.pdf Yes No Fillable Fileable
Form and Instruction CMS-R-235 CMS-R-235.Tab_2d CMS-R-235.Tab_2d_Draft.pdf Yes No Fillable Fileable
Form and Instruction CMS-R-235 CMS-R-235.Tab_2e CMS-R-235.Tab_2e_Draft.pdf Yes No Fillable Fileable
Form and Instruction CMS-R-235 CMS-R-235.Tab_2i CMS-R-235.Tab_2i_Draft.pdf Yes No Fillable Fileable
Form and Instruction CMS-R-235 CMS-R-235.Tab_2j CMS-R-235.Tab_2j_Draft.pdf Yes No Fillable Fileable
Form and Instruction CMS-R-235 CMS-R-235.Tab_2f CMS-R-235.Tab_2f_Draft.pdf Yes No Fillable Fileable

Health Health Care Services

 

2,200 0
   
Private Sector Not-for-profit institutions
 
   0 %

  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 2,200 0 0 0 2,200 0
Annual IC Time Burden (Hours) 1,100 0 0 0 1,100 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.