Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Functional Assessment Standardized Items (FASI): Round 1 Modified 1570 785 0 Instruction
Form and Instruction CMS-10243 Consent Form
Form and Instruction CMS-10243 Functional Assessment Standardized Items (FASI)
Functional Assessment Standardized Items (FASI): Round 2 Removed 0 0 0 Form and Instruction CMS-10243 Functional Assessment Standardized Items (FASI)
Total burden requested under this ICR: 1570 785 0  
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