Information Collection Request

Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA)

ICR 201005-0938-011 · OMB 0938-1096 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
DOTPA - 30DayCommentResponses.doc Supplementary Document Uploaded 2010-06-30 Available
CMS-10298 Supporting Statement B.docx Supporting Statement B Uploaded 2010-04-27 Available
File5_508_CMS-10298PRA_DOTPA_Instrument_Change_Crosswalk_2010_02_25.pdf Supplementary Document Uploaded 2010-04-27 Available
CMS-10298 Response to Comments.pdf Supplementary Document Uploaded 2010-04-27 Available
CMS-10298 Supporting Statement A.docx Supporting Statement A Uploaded 2010-04-27 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
192931 Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA0 Other-Admission Intake Questionnaire New
192930 DATA COLLECTION FOR DEVELOPING OUTPATIENT THERAPY PAYMENT ALTERNATIVES (DOTPA) (CMS-10298) Other-Admission Intake Questionnaire New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2013 36 Months From Approved
38,632 0 0
14,271 0 0
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
DATA COLLECTION FOR DEVELOPING OUTPATIENT THERAPY PAYMENT ALTERNATIVES (DOTPA) (CMS-10298)
Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA0

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 38,632 0 0 38,632 0 0
Annual Time Burden (Hours) 14,271 0 0 14,271 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No