Information Collection

PACE Quality Data Without RCA

IC 213217 under ICR 202009-0938-014 · OMB 0938-1264.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1264 can be found here:

Documents and Forms

Document Name Document Type
PACE Quality Monitoring and Reporting Guidance 2020.pdf Instruction
HPMS PACE Quality Monitoring User Guide.pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PACE Quality Data Without RCA	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			PACE Quality Monitoring and Reporting Guidance 2020.pdf		Yes	Yes	Printable Only
Instruction			HPMS PACE Quality Monitoring User Guide.pdf		Yes	Yes	Printable Only

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

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	1,092	612	480
Annual IC Time Burden (Hours)	146,328	-7,272	153,600
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.