View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Functional Assessment Standardized Items (FASI): Round 1
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction No   Printable Only
Form and Instruction CMS-10243 Yes No Fillable Printable
Form and Instruction CMS-10243 No   Fillable Printable

Health Health Care Services

 

1,570 0
   
Individuals or Households
 
   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 1,570 0 0 0 0 1,570
Annual IC Time Burden (Hours) 785 0 0 0 0 785
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk 12/18/2019
FASI Annotated with Changes 12/18/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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