Waiver Requests (States)

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

OMB: 0938-1326

IC ID: 223826

Information Collection (IC) Details

View Information Collection (IC)

Waiver Requests (States) CM-CPC
No Unchanged
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


5 0
State, Local, and Tribal Governments
   100 %

  Approved 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) 40 0 0 0 0 40
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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