PRECLEARANCE - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) EVALUATION

ICR 199101-0938-003

OMB: 0938-0576

Federal Form Document

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Document
Name
Status
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ICR Details
0938-0576 199101-0938-003
Historical Active
HHS/CMS
PRECLEARANCE - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) EVALUATION
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/03/1991
Retrieve Notice of Action (NOA) 01/03/1991
This preclearance is approved through 3/94 under the condition that agency and contractor reports fully evaluate and explain the limitations in generalizing On Lok's success beyond the 8 proposed sites. In particular, the reports should address the implicit assumptions reflected in the vague criteria for site selection (i.e. sponsorship, state support, history and professional culture). Second, to the greatest extent possible, the Department should increase the number of demonstration sites. Additional demonstration sites would enhance the Department's ability to evaluate all significant variables affecting program performance. Last, this clearance does not cover the PACE data collection manual and forms. HCFA should submit these instruments separately for OMB approval.
  Inventory as of this Action Requested Previously Approved
03/31/1994 03/31/1994
1 0 0
1 0 0
0 0 0

SO AS TO EVALUATE THE CONGRESSIONALLY MANDATED PACE DEMONSTRATION, THIS CONTRACT WILL COLLECT DATA FROM A SAMPLE OF MEDICARE BENEFICIARIE WHO WILL SERVE AS THE COMPARISON GROUP FOR THE PACE SITES. DATA COLLECTED WILL INCLUDE HEALTH AND FUNCTIONAL STATUS AND QUALITY OF LIFE MEASURES.

None
None


No

1
IC Title Form No. Form Name
PRECLEARANCE - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) EVALUATION

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1 0 0 1 0 0
Annual Time Burden (Hours) 1 0 0 1 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/03/1991


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