Development, Adaptation, Implementation, and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE) (CMS-10557)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1185 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10557 Development, Adaptation, Implementation, and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE) (CMS-10557) Form
CMS-10557 Pilot Test Registration Tool PRA PACE QM Survey Form_29-04-2015_10-05-01.pdf Form
Generic Clearance Submission_PACE Quality Measures_v6 [rev 05-01-2015 by OSORA PRA].doc Amended Supporting Statement for Pkg Apporved on March 23, 2015 IC Document

Information Collection (IC) Details

IC Title:	Development, Adaptation, Implementation, and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE) (CMS-10557)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10557	Pilot Test Registration Tool	PRA PACE QM Survey Form_29-04-2015_10-05-01.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Amended Supporting Statement for Pkg Apporved on March 23, 2015	Generic Clearance Submission_PACE Quality Measures_v6 [rev 05-01-2015 by OSORA PRA].doc	05/01/2015

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