Information Collection

Survey of Contract Labor in Selected Health Industries

IC 183298 under ICR 200801-0938-001 · OMB 0938-1036.

Documents and Forms

Document Name Document Type
Form CMS-10177 Survey of Contract Labor in Selected Health Industries Form and Instruction
CMS-10177[1].Draft Cover Letter.doc Other-Survey Cover Letter
CMS-10177 CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND CMS-10177[1].REVISED-Survey Instrument.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey of Contract Labor in Selected Health Industries	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10177	CMS SURVEY OF HOSPITALS, SKILLED NURSING FACILITIES, AND KIDNEY DIALYSIS CENTERS	CMS-10177[1].REVISED-Survey Instrument.doc		Yes	Yes	Fillable Fileable
Other-Survey Cover Letter			CMS-10177[1].Draft Cover Letter.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,640	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,640	3,640
Annual IC Time Burden (Hours)	3,640	3,640
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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