OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Care Coordination Quality Measure for Patients in the Primary Care Setting

OMB 0935-0227 · HHS/AHRQ.

OMB 0935-0227

Latest Forms, Documents, and Supporting Material

Document Name
Form 3 MHI-LV: Non-physician clinician Form and Instruction
Form 2 MHI-LV1: Physician/administrator Form and Instruction
Form 1 Appendix A: CCQM-PC Survey Form and Instruction
Planned Parent Public Comment (2).pdf Supplementary Document
AAFP Public Comment (1).pdf Supplementary Document
Appendix_E_stakeholders list_UPD2.pdf Supplementary Document
Appendix_C_Draft recruitment and consent_UPD4 12 19 14.pdf Supplementary Document
CC_OMB_Supporting Statement Part B_FINAL.docx Supporting Statement B
CC_OMB_Supporting Statement Part A_FINAL 2 12 19 2014.docx Supporting Statement A
MHI-LV: Non-physician clinician Form and Instruction
MHI-LV1: Physician/administrator Form and Instruction
Appendix A: CCQM-PC Survey Form and Instruction

All Historical Document Collections

201410-0935-003

Approved with change

New collection (Request for a new OMB Control Number)

2014-10-31