Business Proposal Forms For Quality Improvement Organizations (QIOs)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0579 can be found here:

Documents and Forms

Document Name Document Type
Form CMS 718-721 Business Proposal Forms For Quality Improvement Organizations (QIOs) Form
CMS-718-721.P9SOW - Instructions - ONC 0938-0579.doc Instruction
CMS-718-721.Travel Form Instructions.doc Instruction
CMS 718-721 CMS 718-721.J-8a 9th SOW CKD Spreadsheet CMS-718-721.J-8a 9th SOW CKD Spreadsheet.xlsx Form
CMS 718-721 CMS 718-721.J-8a 9th SOW Disparities Spreadsheet CMS-718-721.J-8a 9th SOW Disparities Spreadsheet.xlsx Form
CMS-718-721 CMS-718-721.J-8a 9th SOW Patient Pathways Spreadsheet CMS-718-721.J-8a 9th SOW Patient Pathways Spreadsheet.xlsx Form
CMS-718-721 CMS-718-721.Travel Detail Chart CMS-718-721.Travel Detail Chart.xls Form
CMS-718-721 CMS-718-721.BP9SOW - Forms - OCN-0938-0579 CMS-718-721.BP9SOW - Forms - OCN-0938-0579.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Business Proposal Forms For Quality Improvement Organizations (QIOs)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS 718-721	CMS 718-721.J-8a 9th SOW CKD Spreadsheet	CMS-718-721.J-8a 9th SOW CKD Spreadsheet.xlsx	Yes	Yes	Fillable Fileable
Form	CMS 718-721	CMS 718-721.J-8a 9th SOW Disparities Spreadsheet	CMS-718-721.J-8a 9th SOW Disparities Spreadsheet.xlsx	Yes	Yes	Fillable Fileable
Form	CMS-718-721	CMS-718-721.J-8a 9th SOW Patient Pathways Spreadsheet	CMS-718-721.J-8a 9th SOW Patient Pathways Spreadsheet.xlsx	Yes	Yes	Fillable Fileable
Instruction			CMS-718-721.P9SOW - Instructions - ONC 0938-0579.doc	No	No	Fillable Fileable
Form	CMS-718-721	CMS-718-721.Travel Detail Chart	CMS-718-721.Travel Detail Chart.xls	Yes	Yes	Fillable Fileable
Instruction			CMS-718-721.Travel Form Instructions.doc	Yes	Yes	Fillable Fileable
Form	CMS-718-721	CMS-718-721.BP9SOW - Forms - OCN-0938-0579	CMS-718-721.BP9SOW - Forms - OCN-0938-0579.xlsx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21	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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	21	21
Annual IC Time Burden (Hours)	1,785	1,785
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.