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

IC 215707 under ICR 201506-0938-013 · OMB 0938-1185.

Documents and Forms
Document Name
Document Type
Form
Other-Recruitment Reminder Letter
Other-Recruitment Letter
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10557 PACE Pilot Test Evaluation PACE Pilot Test Evaluation Survey.pdf Yes Yes Fillable Printable
Other-Recruitment Reminder Letter PACE_Recruit_Reminder_Letter.pdf No   Paper Only
Other-Recruitment Letter PACE_Recruitment_Letter.pdf No   Paper Only

Health Health Care Services

 

180 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   50 %

  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 46 0 0 0 0 46
Annual IC Time Burden (Hours) 4,035 0 0 0 0 4,035
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement Generic Clearance Submission_PACE Quality Measures_v6 [rev 03-18-2015 by OSORA PRA].doc 03/18/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.