Information Collection

Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration: ONGOING DATA (CMS-10240)

IC 182817 under ICR 200711-0938-010 · OMB 0938-1039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1039 can be found here:

Documents and Forms

Document Name Document Type
CMS-10240 pra-attachments.doc Other-Application, Survey, Data coll
CMS-10240 nhvbp-paperburden.xls CMS-10240 nhvbp-paperburden IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration: ONGOING DATA (CMS-10240)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Application, Survey, Data collection Form, Statistical Methods			CMS-10240 pra-attachments.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 50

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	17,220	17,220
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10240 nhvbp-paperburden	CMS-10240 nhvbp-paperburden.xls	10/11/2007

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