Information Collection

Requirements for PACE Entities

IC 8559 under ICR 202405-0938-007 · OMB 0938-0790.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PACE Manual.docx	Instruction
PACE Manual.docx	Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Requirements for PACE Entities

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 460.82(f) 42 CFR 460.116(c) 42 CFR 460.120(b) and (e) 42 CFR 460.122(b) and (h) 42 CFR 460.124 42 CFR 460.156(a) and (b) 42 CFR 460.132(b) 42 CFR 460.152(b)(4) 42 CFR 460.190(a) 42 CFR 460.196(c) 42 CFR 460.104(c)(3)(iii) 42 CFR 460.201(a)(1) and (c)(1) 42 CFR 460.68(b)(1) and (2) 42 CFR 460.70(b)(1) 42 CFR 460.30(a) and (b) 42 CFR 460.72(a)(3) 42 CFR 460.71(a) 42 CFR 460.102(e)

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				https://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Internet-Only-Manuals- IOMs-Items/CMS019036	No		Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 156

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	221,264	99,972	121,292
Annual IC Time Burden (Hours)	148,056	60,815	87,241
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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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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