Information Collection

Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration: ONGOING DATA(CMS-10240)

IC 182816 under ICR 201009-0938-004 · OMB 0938-1039.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10240.NHVBP-pra.pdf	Other-Form and Instructions

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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-Form and Instructions			CMS-10240.NHVBP-pra.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 178

Number of Respondents for Small Entity: 28

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	712	-288	1,000
Annual IC Time Burden (Hours)	5,530	-26,420	31,950
Annual IC Cost Burden (Dollars)	0	-400,000	400,000

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.