Information Collection

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

IC 189571 under ICR 201001-0938-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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Information Collection (IC) Details

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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: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

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 %

	Approved	Previously Approved
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

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