Information Collection

Executive Summary for Research Identifiable Data (Private Sector)

IC 215655 under ICR 201503-0938-007 · OMB 0938-1276.

Documents and Forms

Document Name Document Type
Form CMS-10522 Executive Summary for Research Identifiable Data (Private Sector) Form and Instruction
CMS-10522 Executive Summary Supplement for Requestors of the NDI C 508_CMS_NDI.pdf Form and Instruction
CMS-10522 EXECUTIVE SUMMARY FOR RESEARCH IDENTIFIABLE DATA CMS Vir 508_CMS_VDRC_508.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Executive Summary for Research Identifiable Data (Private Sector)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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-10522	Executive Summary Supplement for Requestors of the NDI Causes of Death Variables	508_CMS_NDI.pdf		Yes	Yes	Fillable Fileable Signable
Form and Instruction	CMS-10522	EXECUTIVE SUMMARY FOR RESEARCH IDENTIFIABLE DATA CMS Virtual Research Data Center (CMS VRDC) Request	508_CMS_VDRC_508.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 295	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	295	295
Annual IC Time Burden (Hours)	590	590
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.