Business Proposal Formats for Quality Improvement Organizations (QIOs) - previously known as PEER REVIEW ORGANIZATIONS (PROs)

ICR 200302-0938-003

OMB: 0938-0579

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0579 200302-0938-003
Historical Active 199911-0938-002
HHS/CMS
Business Proposal Formats for Quality Improvement Organizations (QIOs) - previously known as PEER REVIEW ORGANIZATIONS (PROs)
Revision of a currently approved collection   No
Regular
Approved with change 05/06/2003
Retrieve Notice of Action (NOA) 02/21/2003
This collection is approved for 3 years. Supporting Statement revised to include Federal Cost estimate. Forms and Instructions packet revised according to correspondence 4/29 and 5/5.
  Inventory as of this Action Requested Previously Approved
07/31/2006 07/31/2006 05/31/2003
20 0 20
455 0 535
0 0 0

The submission of proposal information by current QIOs and other bidders, on the appropriate forms, will satisfy CMS's need for meaningful, consistent, and verifiable data with which to evaluate contract proposals.

None
None


No

1
IC Title Form No. Form Name
Business Proposal Formats for Quality Improvement Organizations (QIOs) - previously known as PEER REVIEW ORGANIZATIONS (PROs) STAFFING, SC1, SC2, CMS-FORM-718BP, 719BP, 720BP, 721BP, SUM

  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 20 20 0 0 0 0
Annual Time Burden (Hours) 455 535 0 0 -80 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
02/21/2003


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