Business Proposal Forms For Quality Improvement Organizations (QIOs)

Business Proposal Forms For Quality Improvement Organizations (QIOs) (CMS-718-721)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.