OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Evaluation of the Multi-payer Advanced Primary Care Practice Demonstration:

IC 210263 under ICR 201402-0938-002 · OMB 0938-1256.

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

View Information Collection (IC)

Evaluation of the Multi-payer Advanced Primary Care Practice Demonstration:
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10485 MAPCP Provider Survey Att D1 - MAPCP Provider Survey_102714 clean.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10485 MAPCP Practice Manager Survey Att D2 - MAPCP Practice Manager Survey_102714 clean.docx Yes Yes Fillable Fileable

Health Health Care Services

 

5,799 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 6,602 0 6,602 0 0 0
Annual IC Time Burden (Hours) 1,160 0 1,160 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk AttE-RevisionsMAPCP-ProvSurv.pdf 02/03/2014
Recruitment Communication Attachment C - 102714 clean.doc 11/13/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.