Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA0

Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1096 can be found here:

Documents and Forms

Document Name Document Type
Appendix A CARE-C_Admission_4-14-2010.pdf Other-Admission Intake Questionnaire
Appendix A CARE-C_Discharge_4-14-2010.pdf Other-Discharge Questionnaire
Appendix A CARE-F_Admission_4-14-2010.pdf Other-Care F Admission Questionnaire
Appendix A CARE-F_Discharge_4-14-2010.pdf Other-Care F Discharge Questionnaire

Information Collection (IC) Details

IC Title:	Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA0	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Admission Intake Questionnaire	Appendix A CARE-C_Admission_4-14-2010.pdf	No	No	Paper Only
Other-Discharge Questionnaire	Appendix A CARE-C_Discharge_4-14-2010.pdf	No	No	Paper Only
Other-Care F Admission Questionnaire	Appendix A CARE-F_Admission_4-14-2010.pdf	No	No	Paper Only
Other-Care F Discharge Questionnaire	Appendix A CARE-F_Discharge_4-14-2010.pdf	No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	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: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,088	6,088
Annual IC Time Burden (Hours)	3,531	3,531
Annual IC Cost Burden (Dollars)	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.