Information Collection

Business Proposal Forms For Quality Improvement Organizations (QIOs)

IC 43659 under ICR 201104-0938-005 · OMB 0938-0579.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS 718-721 CMS 718-721.J-8a 9th SOW Disparities Spreadsheet Business Proposal Forms For Quality Improvement Organizations (QIOs)	Form
Form CMS 718-721 CMS 718-721.J-8a 9th SOW CKD Spreadsheet Business Proposal Forms For Quality Improvement Organizations (QIOs)	Form
Form CMS-718-721 CMS-718-721.J-8a 9th SOW Patient Pathways Spreadsheet Business Proposal Forms For Quality Improvement Organizations (QIOs)	Form
Form CMS-718-721 CMS-718-721.Travel Detail Chart Business Proposal Forms For Quality Improvement Organizations (QIOs)	Form
Form CMS-718-721 CMS-718-721.BP9SOW - Forms - OCN-0938-0579 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

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS 718-721	Yes	Yes	Fillable Fileable
Form	CMS 718-721	Yes	Yes	Fillable Fileable
Form	CMS-718-721	Yes	Yes	Fillable Fileable
Instruction		No	No	Fillable Fileable
Form	CMS-718-721	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Form	CMS-718-721	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 %

table that charts list of burden
	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

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.

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