Level I Monitoring Data Entry

Program of all-Inclusive Care for the Elderly PACE Quality Data Entry in the CMS Health Plan Monitoring System (HPMS) (CMS-10525)

OMB: 0938-1264

IC ID: 213217

Information Collection (IC) Details

View Information Collection (IC)

Level I Monitoring Data Entry
 
No Modified
 
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 PACE Quality Data Entry (Screen Shots) PACE Quality Data Entry HPMS PRA Screen Shots.docx Yes Yes Fillable Fileable
Instruction PRA CMS -10525 Addtional Information Part 1 Quality Reporting_23-05-2016_15-59-03.pdf No   Printable Only
Instruction PRA CMS -10525 Additional Information Part 2 Quality Reporting_23-05-2016_15-58-07.pdf No   Printable Only
Instruction PRA CMS -10525 Additional Information Part 3 Quality Reporting_23-05-2016_16-02-49.pdf No   Printable Only
Instruction PACE Level I Guidance 2016.pdf No   Printable Only

Health Health Care Services

 

120 0
   
Private Sector Businesses or other for-profits
 
   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 480 0 -23,520 0 0 24,000
Annual IC Time Burden (Hours) 153,600 0 147,600 0 0 6,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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