Information Collection

Requirements for PACE Entities

IC 8559 under ICR 202001-0938-012 · OMB 0938-0790.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0790 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Requirements for PACE Entities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 460.70(b)(1) 42 CFR 460.30(a) and (b) 42 CFR 460.71(a) 42 CFR 460.68(b)(1) and (2) 42 CFR 460.72(a)(3) 42 CFR 460.82(f) 42 CFR 460.102(e) 42 CFR 460.104(c)(3)(iii) 42 CFR 460.116(c) 42 CFR 460.120(b) and (e) 42 CFR 460.122(b) and (h) 42 CFR 460.124 42 CFR 460.132(b) 42 CFR 460.152(b)(4) 42 CFR 460.156(a) and (b) 42 CFR 460.190(a) 42 CFR 460.196(c) 42 CFR 460.201(a)(1) and (c)(1)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 134	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	77,560	77,430	130
Annual IC Time Burden (Hours)	63,321	1,981	61,340
Annual IC Cost Burden (Dollars)	0	0	0

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