Information Collection Request

Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project (CMS-10209)

ICR 201804-0938-016 · OMB 0938-1023 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10209 Attestations Form Modified Available
CMS-10209- Supporting Statement A - Passback_8_20_18.docx Supporting Statement A Uploaded 2018-11-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
229160 Attestations Form Modified
179877 Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project Instruction Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2021 36 Months From Approved 07/31/2017
750 0 1,904
188 0 28,560
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 750 1,904 750 -1,904 0 0
Annual Time Burden (Hours) 188 28,560 188 -28,560 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No