Application Requirements (POs)

The PACE Organization Application Process in 42 CFR Part 460 (CMS-10631)

OMB: 0938-1326

IC ID: 223821

Information Collection (IC) Details

View Information Collection (IC)

Application Requirements (POs)
 
No Modified
 
Mandatory
 
42 CFR 460.12(a)(1)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10631 PACE Application PACE Paper Application_FINAL_01102022.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10631 HPMS_ SAE PACE Application PACE Blank Attestations - SAE.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10631 HPMS_ Initial PACE Application PACE Blank Attestations - Initial.pdf Yes Yes Fillable Printable

Health Health Care Services

 

45 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 45 0 0 0 0 45
Annual IC Time Burden (Hours) 2,595 0 45 0 0 2,550
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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