Evaluation of the Implementation and Impact of Pay-for-Quality Programs

Documents and Forms

Document Name Document Type
SNAP P4Q Supporting Documents - Appendix.doc Other-Other
Interview Protocol Revised 6-19.doc Interview Protocol Revised 6-19 IC Document
Survey Instrument - BMC Version Revised 6-19.doc Survey Instrument - BMC Version Revised 6-19 IC Document
Survey Instrument - Montefiore Version Revised 6-19.doc Survey Instrument - Montefiore Version Revised 6-19 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation of the Implementation and Impact of Pay-for-Quality Programs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.6

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Other			SNAP P4Q Supporting Documents - Appendix.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	114	114
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Interview Protocol Revised 6-19	Interview Protocol Revised 6-19.doc	06/28/2007
Survey Instrument - BMC Version Revised 6-19	Survey Instrument - BMC Version Revised 6-19.doc	06/28/2007
Survey Instrument - Montefiore Version Revised 6-19	Survey Instrument - Montefiore Version Revised 6-19.doc	06/28/2007

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