Form CMS-10680 EVV Personal Care Services (PCS) Survey

Personal Care Services

June 5, 2019

HCBS EVV State Compliance Survey Screenshots

PRA Disclosure Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-TBD  (Expires: TBD).  This information collection is mandatory for states to complete in order to demonstrate compliance with section 1903(l) of the Social Security Act. States that are otherwise fully compliant with the requirements may experience Federal Medical Assistance Percentage (FMAP) reductions per section 1903(l)(1) of the Social Security Act if they do not complete this information collection. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law.  The time required to complete the information collection is estimated to average 130-150 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

 

Electronic Visit Verification Landing Page

<number>

<number>

 

State Compliance Survey CMS Landing Page

<number>

<number>

 

State Compliance Survey – PCS Question ID 0

 

State Compliance Survey – PCS Question ID 1

<number>

<number>

 

State Compliance Survey – PCS Question ID 2

<number>

<number>

 

 State Compliance Survey – PCS Question ID 3

<number>

<number>

 

State Compliance Survey – PCS Question ID 4

<number>

<number>

 

State Compliance Survey – PCS Question ID 5

<number>

<number>

 

State Compliance Survey – PCS Question ID 6

<number>

<number>

 

State Compliance Survey – PCS Question ID 7

<number>

<number>

 

State Compliance Survey – PCS Question ID 8

<number>

<number>

 

State Compliance Survey – PCS Question ID 9

<number>

<number>

 

State Compliance Survey – PCS Question ID 10

<number>

<number>

 

State Compliance Survey – PCS Question ID 11

<number>

<number>

 

State Compliance Survey – PCS Question ID 12

<number>

<number>

 

State Compliance Survey – PCS Question ID 13

<number>

<number>

 

State Compliance Survey – PCS Question ID 14

<number>

<number>

 

State Compliance Survey – PCS Question ID 15

<number>

<number>

 

State Compliance Survey – PCS Question ID 16

<number>

<number>

 

State Compliance Survey – PCS Question ID 17

<number>

<number>

 

State Compliance Survey – PCS Question ID 18

<number>

<number>

 

State Compliance Survey – PCS Question ID 19

<number>

<number>

 

State Compliance Survey – PCS Question ID 20

<number>

<number>

 

State Compliance Survey – PCS Question ID 21

<number>

<number>

 

State Compliance Survey – PCS Question ID 22

<number>

<number>

 

State Compliance Survey – PCS Question ID 23

<number>

<number>

 

State Compliance Survey – PCS Question ID 24

<number>

<number>

 

State Compliance Survey – PCS Question ID 25

<number>

<number>

 

State Compliance Survey – PCS Question ID 26

<number>

<number>

 

State Compliance Survey – PCS Question ID 27

<number>

<number>

 

State Compliance Survey – PCS Question ID 28

<number>

<number>

 

State Compliance Survey – PCS Question ID 29

<number>

<number>

 

State Compliance Survey – PCS Question ID 30

<number>

<number>

 

State Compliance Survey – PCS Question ID 31

<number>

<number>

 

State Compliance Survey – PCS Question ID 32

<number>

<number>

 

State Compliance Survey – PCS Question ID 33

<number>

<number>

 

State Compliance Survey – PCS Question ID 34

<number>

<number>

 

State Compliance Survey – PCS Question ID 35

<number>

<number>

 

State Compliance Survey – PCS Question ID 36

<number>

<number>

 

State Compliance Survey – PCS Question ID 37

<number>

<number>

 

State Compliance Survey – PCS Question ID 38

<number>

<number>

 

State Compliance Survey – PCS Question ID 39

<number>

<number>

 

State Compliance Survey – PCS Question ID 40

 

State Compliance Survey – PCS Question ID 41

 

State Compliance Survey – PCS Question ID 42

 

State Compliance Survey – PCS Question ID 43

 

State Compliance Survey – PCS Question ID 44

 

State Compliance Survey – PCS Question ID 45

 

State Compliance Survey – PCS Question ID 46

<number>

<number>

 

File Type	application/vnd.openxmlformats-officedocument.presentationml.presentation
File Modified	0000-00-00
File Created	0000-00-00

---

© 2024 OMB.report | Privacy Policy

---