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Evaluation of the Program of All-Inclusive Care for the Elderly (PACE) Demonstration
Evaluation of the Program of All-Inclusive Care for the Elderly (PACE) Demonstration
OMB: 0938-0662
IC ID: 8243
OMB.report
HHS/CMS
OMB 0938-0662
ICR 199605-0938-002
IC 8243
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Evaluation of the Program of All-Inclusive Care for the Elderly (PACE) Demonstration
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
HCFA-R-165
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,833
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
3,739
0
-936
0
0
4,675
Annual IC Time Burden (Hours)
3,745
0
-1,691
0
0
5,436
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.