Information Collection Request

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

ICR 202411-0938-003 · OMB 0938-1326 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10631 PACE Application Form and Instruction Modified Available
Form CMS-10631 Waiver Requests (States) Form and Instruction Modified Repair queued
Form CMS-10631 PACE Application Form and Instruction Modified Available
Form CMS-10631 Waiver Requests (POs) Form and Instruction Modified Repair queued
Form CMS-10631 PACE Application Form and Instruction Modified Available
Form CMS-10631 State Readiness Review (States) Form and Instruction Modified Repair queued
Form CMS-10631 PACE Application Form and Instruction Modified Available
Form CMS-10631 Support of State Readiness Review (POs) Form and Instruction Modified Repair queued
Form CMS-10631 PACE Application Form and Instruction Modified Available
Form CMS-10631 Application Requirements (POs) Form and Instruction Modified Available
National PACE.pdf Public Comments Uploaded 2024-10-04 Repair queued
PACE Summary of Changes_Off Cycle PRA_2024.docx Supplementary Document Uploaded 2024-11-08 Available
PACE Summary of Changes_Off Cycle PRA_2024.docx Supplementary Document Uploaded 2024-11-08 Repair queued
CMS-10631 - Supporting Statement_clean.docx Supporting Statement A Uploaded 2024-11-08 Available
CMS-10631 - Supporting Statement_clean.docx Supporting Statement A Uploaded 2024-11-08 Available
Responses to 60-day comments_CMS-10631_102924clean.docx Supplementary Document Uploaded 2024-11-08 Available
Responses to 60-day comments_CMS-10631_102924clean.docx Supplementary Document Uploaded 2024-11-08 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
223826 Waiver Requests (States) Form and Instruction ModifiedPACE Application
223826 Waiver Requests (States) Form and Instruction Modified
223824 Waiver Requests (POs) Form and Instruction ModifiedPACE Application
223824 Waiver Requests (POs) Form and Instruction Modified
223823 State Readiness Review (States) Form and Instruction ModifiedPACE Application
223823 State Readiness Review (States) Form and Instruction Modified
223822 Support of State Readiness Review (POs) Form and Instruction ModifiedPACE Application
223822 Support of State Readiness Review (POs) Form and Instruction Modified
223821 Application Requirements (POs) Form and Instruction ModifiedPACE Application
223821 Application Requirements (POs) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2028 36 Months From Approved 10/31/2025
109 0 109
7,271 0 7,271
0 0 0





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
Application Requirements (POs) CMS-10631
State Readiness Review (States) CMS-10631
Support of State Readiness Review (POs) CMS-10631
Waiver Requests (POs) CMS-10631
Waiver Requests (States) CMS-10631

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 109 109 0 0 0 0
Annual Time Burden (Hours) 7,271 7,271 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No