Information Collection

GenIC #26 Nursing Home Career Outreach Tracker

IC 269721 under ICR 202407-0938-019 · OMB 0938-1247.

Documents and Forms

Document Name Document Type
Form CMS-10427 (GenIC#2 GenIC #26 Nursing Home Career Outreach Tracker Form and Instruction
CMS-10427 (GenIC#2 Nursing Home Career Outreach Tracker CMS-10437.GenIC#26 - Attachment 3 Nursing Home Career Survey Instrument 07242023 (PRA edits).docx Form and Instruction
CMS-10427 (GenIC#2 Nursing Home Career Outreach Tracker CMS-10437.GenIC#26 - Attachment 3 Nursing Home Career Survey Instrument 07242023 (PRA edits).docx Form and Instruction
CMS-10437.GenIC#26 Attachment 1 NHS quant (Study Initiation Form).docx CMS-10437.GenIC#26 Attachment 1 NHS quant (Study Initiation Form) IC Document
CMS-10437.GenIC#26 Attachment 1 NHS quant (Study Initiation Form).docx CMS-10437.GenIC#26 Attachment 1 NHS quant (Study Initiation Form) IC Document
CMS-10437.GenIC#26 Attachment 4 NHS quant burden hrs (Supporting Statement).docx CMS-10437.GenIC#26 Attachment 4 NHS quant burden hrs (Supporting Statement) IC Document
CMS-10437.GenIC#26 Attachment 4 NHS quant burden hrs (Supporting Statement).docx CMS-10437.GenIC#26 Attachment 4 NHS quant burden hrs (Supporting Statement) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	GenIC #26 Nursing Home Career Outreach Tracker	Agency IC Tracking Number:

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-10427 (GenIC#26)	Nursing Home Career Outreach Tracker	CMS-10437.GenIC#26 - Attachment 3 Nursing Home Career Survey Instrument 07242023 (PRA edits).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10437.GenIC#26 Attachment 1 NHS quant (Study Initiation Form)	CMS-10437.GenIC#26 Attachment 1 NHS quant (Study Initiation Form).docx	08/06/2024
CMS-10437.GenIC#26 Attachment 4 NHS quant burden hrs (Supporting Statement)	CMS-10437.GenIC#26 Attachment 4 NHS quant burden hrs (Supporting Statement).docx	08/06/2024

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