Information Collection

Medicare and Medicaid; Programs For All-Inclusive Care For The Elderly (PACE) Contained in 42 CFR 460.12-460.210

IC 8559 under ICR 200701-0938-006 · OMB 0938-0790.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0790 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Justification for ER PRA Clearance 10 24 06JP.doc Emergency Justification	IC Document

IC Title:

Medicare and Medicaid; Programs For All-Inclusive Care For The Elderly (PACE) Contained in 42 CFR 460.12-460.210

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 460.68(b)(1) 42 CFR 460.68(b)(2)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

Number of Respondents for Small Entity: 2

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	54	0	54
Annual IC Time Burden (Hours)	35,902	-8,476	44,378
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Emergency Justification	Justification for ER PRA Clearance 10 24 06JP.doc	11/09/2006

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