Information Collection

Business Proposal Forms For Quality Improvement Organizations (QIOs)

IC 43659 under ICR 202104-0938-007 · OMB 0938-0579.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-718-721 Business Proposal Forms For Quality Improvement Organizations (QIOs)	Form
BPInstructions.pdf	Instruction
CMS-718-721 Business Proposal Forms BP Forms.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-718-721	Business Proposal Forms	BP Forms.pdf		Yes	Yes	Fillable Fileable
Instruction			BPInstructions.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 58

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	58	-127	185
Annual IC Time Burden (Hours)	2,320	-6,930	9,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.