OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA0

IC 192931 under ICR 201005-0938-011 · OMB 0938-1096.

Documents and Forms
Document Name
Document Type
Other-Admission Intake Questionnaire
Other-Discharge Questionnaire
Other-Care F Admission Questionnaire
Other-Care F Discharge Questionnaire
Information Collection (IC) Details

View Information Collection (IC)

Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA0
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL 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

Health Health Care Services

 

52 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 6,088 0 6,088 0 0 0
Annual IC Time Burden (Hours) 3,531 0 3,531 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.