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Federal forms, ICRs, and supporting documents

Information Collection

DATA COLLECTION FOR ADMINISTERING THE MEDICARE CONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (volunteers)

IC 183092 under ICR 200712-0938-005 · OMB 0938-1037.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

DATA COLLECTION FOR ADMINISTERING THE MEDICARE CONTINUITY ASSESSMENT RECORD AND EVALUATION (CARE) INSTRUMENT (volunteers)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10243 CARE Tool CMS-10243.Appendix B MASTER CARE Tool 30 Day Revisions 103107.doc Yes No Fillable Fileable

Health Health Care Services

 

238 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 149,940 0 149,940 0 0 0
Annual IC Time Burden (Hours) 112,500 0 112,500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CAREPrototypeScreens20070716 CAREPrototypeScreens20070716.ppt 11/15/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.