Information Collection

Business Proposal Forms For Quality Improvement Organizations (QIOs)

IC 43659 under ICR 201801-0938-009 · OMB 0938-0579.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0579 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-718-721 Business Proposal Forms For Quality Improvement Organizations (QIOs)	Form
BP Instructions.docx	Instruction
CMS-718-721 Business Proposal Forms BP Forms.XLSX	Form

IC Title:

Business Proposal Forms For Quality Improvement Organizations (QIOs)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-718-721	Business Proposal Forms	BP Forms.XLSX		Yes	Yes	Fillable Fileable
Instruction			BP Instructions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 185

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	185	165	20
Annual IC Time Burden (Hours)	9,250	8,250	1,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.