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Federal forms, ICRs, and supporting documents

Information Collection

Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA): Data Collection in Community-Based Settings (CMS-10298)

IC 192930 under ICR 201012-0938-004 · OMB 0938-1096.

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

View Information Collection (IC)

Data Collection for Developing Outpatient Therapy Payment Alternatives (DOTPA): Data Collection in Community-Based Settings (CMS-10298)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Care C Admossion Questionnaire:updated Upd 11.10.10_CARE-C_Admission_Highlights_11.10.10_5PM.doc 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
Other-Care C Admission Questionnaire CMS-10298.Appendix A CARE-C_Admission_4-14-2010.pdf No No Paper Only
Other-Care F Admission Questionnaire: updates Upd 11.10.10 CARE-F_Admission_Nursing Facilities_Highlights_11.10.10_5PM.doc No No Paper Only

Health Health Care Services

 

138 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 32,544 0 0 0 0 32,544
Annual IC Time Burden (Hours) 16,272 0 0 5,532 0 10,740
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.