Information Collection

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

IC 183149 under ICR 200712-0938-006 · OMB 0938-1038.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CSM-10246 Cost and Resource Utilization (CRU) Data Collection for the Medicare Post Acute Care Payment Reform Demonstration (Interviews - Site Coordinator)	Form
CSM-10246 CMS-10246.coordinator_guide_HHA CMS-10246.coordinator_guide_HHA_16nov2007.doc	Form
CMS-10246 CMS-10246.coordinator_guide_inst CMS-10246.coordinator_guide_inst_16nov2007.doc	Form

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CSM-10246	CMS-10246.coordinator_guide_HHA	CMS-10246.coordinator_guide_HHA_16nov2007.doc		Yes	Yes	Fillable Fileable
Form	CMS-10246	CMS-10246.coordinator_guide_inst	CMS-10246.coordinator_guide_inst_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: 138

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	138	138
Annual IC Time Burden (Hours)	13,386	13,386
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.