OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Evaluation of Practice Models for Dual Eligibles and Medicare Beneficiaries with Serious Chronic Conditions

OMB 0938-1120 · HHS/CMS.

OMB 0938-1120

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10356 In-person Discussions Form and Instruction
Form CMS-10356 Pre-site Discussions Form and Instruction
CMS-10356.Emergency Justification(1-21-11).docx Supplementary Document
CMS-10356.Supporting Statement Part B (1-14-11).docx Supporting Statement B
CMS-10356.Duals_ProjectDescription_FieldWork.doc Supplementary Document
CMS-10356.Duals_SiteVisitInvitationPACE_Final.doc Supplementary Document
CMS-10356.Emergency Justification.docx Supplementary Document
CMS-10356.Duals_SiteVisitGenericInvitation.doc Supplementary Document
CMS-10356.REVISED - Supporting Statement Part A (1-14-11).docx Supporting Statement A
In-person Discussions Form and Instruction
Pre-site Discussions Form and Instruction

All Historical Document Collections

201011-0938-014

Approved with change

New collection (Request for a new OMB Control Number)

2010-11-26