Medicare Care Management Performance Demonstration (MCMP) Standardized Ambulatory Care Quality Measure Collection Initiative

ICR 200502-0938-006

OMB: 0938-0941

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0941 200502-0938-006
Historical Active
HHS/CMS
Medicare Care Management Performance Demonstration (MCMP) Standardized Ambulatory Care Quality Measure Collection Initiative
New collection (Request for a new OMB Control Number)   No
Emergency 04/01/2005
Approved without change 04/26/2005
Retrieve Notice of Action (NOA) 02/18/2005
  Inventory as of this Action Requested Previously Approved
08/31/2005 08/31/2005
800 0 0
15,200 0 0
0 0 0

The Centers for Medicare and Medicaid Services intends to use these forms to collect information needed to implement Congressionally mandated and high priority Medicare demonstration. The forms in this information collection will be used to reward physician groups for improvements in the quality of care and services delivered to Medicare fee-for-service beneficiaries.

None
None


No

1
IC Title Form No. Form Name
Medicare Care Management Performance Demonstration (MCMP) Standardized Ambulatory Care Quality Measure Collection Initiative 10136

  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 800 0 0 800 0 0
Annual Time Burden (Hours) 15,200 0 0 15,200 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
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.
02/18/2005


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