Information Collection

The Medicare Acute Care Episode Demonstration (CMS-10317)

IC 194759 under ICR 201009-0938-019 · OMB 0938-1117.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ACE OMB FocusGroup-and-Interview Protocols.pdf	Other-Focus Group and Interview Prot
ACE OMB SiteVisitCorrespondence.pdf ACE OMB SiteVisitCorrespondence	IC Document
ACE OMB SiteVisit_2_Correspondence.pdf ACE OMB SiteVisit_2_Correspondence	IC Document
ACE OMB MMA.pdf ACE OMB MMA	IC Document
ACE OMB Social Security Act.pdf ACE OMB Social Security Act	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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-Focus Group and Interview Protocols			ACE OMB FocusGroup-and-Interview Protocols.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 509

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	509	509
Annual IC Time Burden (Hours)	764	764
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ACE OMB SiteVisitCorrespondence	ACE OMB SiteVisitCorrespondence.pdf	09/09/2010
ACE OMB SiteVisit_2_Correspondence	ACE OMB SiteVisit_2_Correspondence.pdf	09/09/2010
ACE OMB MMA	ACE OMB MMA.pdf	09/09/2010
ACE OMB Social Security Act	ACE OMB Social Security Act.pdf	09/09/2010

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