OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Request for Application

IC 242932 under ICR 202305-0938-016 · OMB 0938-1388.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Request for Application
 
No Modified
 
Voluntary
 
42 CFR 1866F  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10728 Participant's OUD Care Team Attachment 1_ViT OUD Care Team_508.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10728 OUD Care Team Roster Guidance & Template ViTOUDCareTeam_Attachment 1.xlsx Yes Yes Fillable Printable
Form and Instruction CMS-10728 Request for Application RFA_Value in Treatment FINAL.docx Yes Yes Fillable Printable

Health Health Care Services

Master Demonstration, Evaluation, and Research Studies for the Office of Research Development and Information (DERS)  83 FR 6591

100 0
   
Private Sector Businesses or other for-profits
 
   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 100 0 0 0 0 100
Annual IC Time Burden (Hours) 200 0 0 0 0 200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.