OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration: Interview Protocols

IC 208578 under ICR 201309-0938-007 · OMB 0938-1223.

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

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Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration: Interview Protocols
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10483 Medical Home Survey PCMCH_Attachment_1_Survey_1_2013_V_3.0.pdf No No Fillable Fileable
Form and Instruction CMS-10483 Medical Home Survey - Spanish version PCMCH_Attachment_Survey_Spanish_2_2013_V_1.0.pdf No No Fillable Fileable

Health Health Care Services

 

10,038 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 10,038 0 10,038 0 0 0
Annual IC Time Burden (Hours) 3,313 0 3,313 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letter First Mailing PCMCH_OMB_Attach_Cover_Letter_First_Mailing_1_2013_V_3.0.pdf 09/03/2013
Cover Letter First Mailing - Spanish version PCMCH_OMB_Attach_Cover_Letter_First_Mailing_1_2013_V_3.0_SPA.pdf 09/03/2013
Cover Letter Second Mailing PCMCH_OMB_Attach_Cover_Letter_Second_Mailing_1_2013_V_3.0.pdf 09/03/2013
Cover Letter Second Mailing - Spanish version PCMCH_OMB_Attach_Cover_Letter_Second_Mailing_1_2013_V_3 0_SPA.pdf 09/03/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.