Information Collection Request

Programs of All-Inclusive Care for the Elderly (PACE) PACE Quality Data Monitoring and Reporting (10525)

ICR 202009-0938-014 · OMB 0938-1264 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10525 Quality Measure(s) Data Entry Form and Instruction Removed Available
PACE Quality Data CMS-10525 - Supporting Statement.docx Supporting Statement A Uploaded 2020-09-28 Available
Appendix A-CMS 10525 Response to Public Comments 60 day.pdf Supplementary Document Uploaded 2020-09-24 Available
PACE Quality Data CMS 10525 final Crosswalk.pdf Supplementary Document Uploaded 2020-09-24 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
224797 Quality Measure(s) Data Entry Form and Instruction Removed
214270 PACE Quality Data With RCA Instruction Modified
213217 PACE Quality Data Without RCA Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2023 36 Months From Approved
1,143 0 0
173,664 0 0
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Quality Measure(s) Data Entry CMS-10525 PACE Quality Data Entry (Screen Shots)
PACE Quality Data With RCA
PACE Quality Data Without RCA

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 1,143 0 0 0 -297 1,440
Annual Time Burden (Hours) 173,664 0 0 0 -156,936 330,600
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No