Information Collection

PACE Quality Data With RCA

IC 214270 under ICR 202312-0938-001 · OMB 0938-1264.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PACE Quality Monitoring & Reporting Guidance March 2021.pdf	Instruction
PACE Quality Monitoring & Reporting Guidance March 2021.pdf	Instruction
HPMS PACE Quality Monitoring User Guide.pdf	Instruction
HPMS PACE Quality Monitoring User Guide.pdf	Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					Yes	No	Printable Only
Instruction					Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 152

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	64	13	51
Annual IC Time Burden (Hours)	38,912	11,576	27,336
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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