Support of State Readiness Review (POs)

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

OMB: 0938-1326

IC ID: 223822

Documents and Forms
Information Collection (IC) Details

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Support of State Readiness Review (POs) CM-CPC
No Unchanged
42 CFR 460.12(b)(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_01212020_FINAL.pdf Yes Yes Fillable Printable

Health Health Care Services


27 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 27 0 0 0 0 27
Annual IC Time Burden (Hours) 1,296 0 0 0 0 1,296
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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