Waiver Requests (POs)

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

OMB: 0938-1326

IC ID: 223824

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Waiver Requests (POs) CM-CPC
 
No Unchanged
 
Mandatory
 
42 CFR 460.26

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

 

10 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 5 0 0 0 0 5
Annual IC Time Burden (Hours) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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