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Mapping and Questionnaire Documents IA 30628 A4 (CMS) 30628 M4
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 30628 Q_CGSDMEB_Web_Browse_20180907_DOT Q_CGSDMEB_Web_Browse_20180907_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_CGSDMEC_Web_Browse_20180907_DOT Q_CGSDMEB_Web_Browse_20180907_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_CGSJ15_Web_Browse_20180907_DOT Q_CGSJ15_Web_Browse_20180907_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_CMS-FCSO_Web_Browse_20170214 Q_CMS-FCSO_Web_Browse_20170214.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_NGSJ6_Web_Browse_20180618_DOT Q_NGSJ6_Web_Browse_20180618_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_NGSJK_Web_Browse_20180618_DOT Q_NGSJK_Web_Browse_20180618_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_NordDmeJa_Web_Browse_20161227 Q_NordDmeJa_Web_Browse_20161227.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_NordJE_Web_Browse_20180418_DOT Q_NordJE_Web_Browse_20180418_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_NordJf_Web_Browse_20161227 Q_NordJf_Web_Browse_20161227.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_Novitas-JH_Web_Browse_20170221_DOT Q_Novitas-JH_Web_Browse_20170221_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_Novitas-JL_Web_Browse_20180124_DOT Q_Novitas-JL_Web_Browse_20180124_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_PalmettoGBA_JJ_Web_Browse_20180108_DOT Q_PalmettoGBA_JJ_Web_Browse_20180108_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_PalmettoGBA_Web_Browse_20170329 Q_PalmettoGBA_Web_Browse_20170329.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_WPSJ5_Web_Browse_20180202_DOT Q_WPSJ5_Web_Browse_20180202_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 30628 Q_WPSJ5_Web_Browse_20180202_DOT Q_WPSJ8_Web_Browse_20180212_DOT.xlsx Yes Yes Fillable Fileable

General Government Central Records & Statistical Mgt

 

3,600 0
   
Individuals or Households
 
   100 %

  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 3,600 0 3,600 0 0 0
Annual IC Time Burden (Hours) 150 0 150 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
1090-0008 Generic Clearance Request Form_CMS Survey_IA 30628 Amend 4 1090-0008 Generic Clearance Request Form_CMS Survey_IA 30628 Amend 4.pdf 02/19/2019
OMB Mapping 2018-2019 Survey (CMS) IA 30628 Amend 4 OMB Mapping 2018-2019 Survey (CMS) IA 30628 Amend 4.xlsx 02/19/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.