Information Collection

Business Proposal Forms For Quality Improvement Organizations (QIOs)

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Business Proposal Forms For Quality Improvement Organizations (QIOs)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection 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 %

	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

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.