Information Collection

Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration

IC 8793 under ICR 200809-0938-015 · OMB 0938-0941.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0941 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration Form and Instruction
CMS-10136 MCMP PAT MCMP PAT Screenshots 052508(B).ppt Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10136	MCMP PAT	MCMP PAT Screenshots 052508(B).ppt		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Demonstration, Evaluation and Research Studies (DERS)	FR Citation: 72 FR 17918

Number of Respondents: 650	Number of Respondents for Small Entity: 650

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	650	-150	800
Annual IC Time Burden (Hours)	15,600	-3,600	19,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.