Level I Monitoring Data Entry

Health Plan Monitoring System Level I and Level II Data Entry for the Program of all-Inclusive Care for the Elderly (CMS-10525)

OMB: 0938-1264

IC ID: 213217

Information Collection (IC) Details

View Information Collection (IC)

Level I Monitoring Data Entry
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10525 Level I Monitoring Data Entry LEVEL ONE HPMS Module May 1 2014 Example- Data Entry DM.pptx Yes Yes Fillable Printable

Health Health Care Services

 

100 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Requested 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 24,000 24,000 0 0 0 0
Annual IC Time Burden (Hours) 6,000 6,000 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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