OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

State Readiness Review (States)

IC 223823 under ICR 202411-0938-003 · OMB 0938-1326.

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

View Information Collection (IC)

State Readiness Review (States)
 
No Modified
 
Mandatory
 
42 CFR 460.12(b)(1)

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 Application_clean_062024.docx Yes Yes Fillable Printable

Health Health Care Services

 

27 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 27 0 0 0 0 27
Annual IC Time Burden (Hours) 3,240 0 0 0 0 3,240
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
PACE Application combined review__redline PACE Application combined review__redline_062024.docx 11/08/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.