Information Collection

Evaluation of the Medicare Care Management Performance Demonstration (Office System Survey)

IC 189571 under ICR 200906-0938-009 · OMB 0938-1072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1072 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
EHRD OSS w trk chg 040309.doc	Other-Survey (Track Changes)

IC Title:

Evaluation of the Medicare Care Management Performance Demonstration (Office System Survey)

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
Other-Survey (Track Changes)			EHRD OSS w trk chg 040309.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 980

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	980	980
Annual IC Time Burden (Hours)	470	470
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.