Information Collection

Cost and Resource Utilization (CRU) Data Collection for the Medicare Post Acute Care Payment Reform Demonstration (Interviews non-cru)

IC 183147 under ICR 200712-0938-006 · OMB 0938-1038.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10246 Cost and Resource Utilization (CRU) Data Collection for the Medicare Post Acute Care Payment Reform Demonstration (Interviews non-cru)	Form and Instruction
CMS-10246 CMS-10246.interview_hha_admin CMS-10246.interview_hha_admin_16nov2007.doc	Form and Instruction
CMS-10246 CMS-10246.interview_hha_mgmt CMS-10246.interview_hha_mgmt_16nov2007.doc	Form and Instruction
CMS-10246 CMS-10246.interview_inst_admin CMS-10246.interview_inst_admin_16nov2007.doc	Form and Instruction
CMS-10246 CMS-10246.interview_inst_finance CMS-10246.interview_inst_finance_16nov2007.doc	Form and Instruction
CMS-10246 CMS-10246.interview_inst_mgmt CMS-10246.interview_inst_mgmt_16nov2007.doc	Form and Instruction
CMS-10246 CMS-10246.nterview_hha_finance CMS-10246.nterview_hha_finance_16nov2007.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10246	CMS-10246.interview_hha_admin	CMS-10246.interview_hha_admin_16nov2007.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10246	CMS-10246.interview_hha_mgmt	CMS-10246.interview_hha_mgmt_16nov2007.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10246	CMS-10246.interview_inst_admin	CMS-10246.interview_inst_admin_16nov2007.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10246	CMS-10246.interview_inst_finance	CMS-10246.interview_inst_finance_16nov2007.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10246	CMS-10246.interview_inst_mgmt	CMS-10246.interview_inst_mgmt_16nov2007.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10246	CMS-10246.nterview_hha_finance	CMS-10246.nterview_hha_finance_16nov2007.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Post Acute Care Payment Reform / Continuity of Assessment Record and Evaluation (PAC-CARE), System No. 09-70-0569

FR Citation: 72 FR 55225

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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