OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Prospective Evaluation of Evidence-Based Community Wellness and Prevention Programs (CMS-10509)

OMB 0938-1252 · HHS/CMS.

OMB 0938-1252

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10509 Program Participants Survey Form and Instruction
Form CMS-10509 National Readiness Survey Form and Instruction
RTC_CommunityBasedWellnessPrograms.pdf Supplementary Document
8926 04 13 12 13 Expedited approval of CMS Wellness Eval.pdf Supplementary Document
OMB_Draft_Wellness_Eval_Part_B_Attachment_1_Sources_of_Survey_Items_03112014.pdf Supplementary Document
OMB_Wellness_Eval_Part_B_09052014_clean.docx Supporting Statement B
OMB_Wellness_Eval_Part_A_09052014_clean.docx Supporting Statement A
Program Participants Survey Form and Instruction
National Readiness Survey Form and Instruction

All Historical Document Collections

201404-0938-008

Approved with change

New collection (Request for a new OMB Control Number)

2014-04-28