OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

For-Profit PACE Study

IC 203502 under ICR 201207-0938-006 · OMB 0938-1180.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

For-Profit PACE Study
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10427 PACE Survey 06965_PACE_OMB_APP_B_06_20_12.docx No No Fillable Fileable

Health Health Care Services

 

813 0
   
Individuals or Households
 
   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 813 813 0 0 0 0
Annual IC Time Burden (Hours) 447 447 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk CMS-10427 Crosswalk CMS-10427.doc 07/18/2012
CMS-10427 Appendix A 10 24 12 CMS-10427 Appendix A 10 24 12.docx 10/25/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.