OMB control number

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

OMB 0938-1326 · HHS/CMS.

OMB 0938-1326

Initial application requirements for the PACE program are currently set forth in 42 CFR 460.12 and in the PACE Manual, Ch. 17. Until recently, the submission of initial and SAE PACE applications and supporting information was in paper format. These applications are often hundreds of pages long, expensive to reproduce and transmit, and administratively inefficient, as staff reviewing different parts of the application are located in different physical locations and must receive hard copies of the material. However, beginning in 2016, initial PACE applications are being submitted via a new automated, electronic submission process. As with initial applications, an application also must be submitted for a PO that seeks to expand its service area and/or add a new service site, and with OMB approval, an automated application process will now also be required of PACE organizations submitting service area expansion applications. In pursuing this new information collection package, we are extracting this component only from the existing OMB approval for the PACE program (CMS-R-244, OMB Control Number 0938-0790).

The latest form for The PACE Organization Application Process in 42 CFR Part 460 (CMS-10631) expires 2028-01-31 and is listed under ICR 202411-0938-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-10631 PACE ApplicationForm and Instruction
Form CMS-10631 Waiver Requests (States)Form and Instruction
Form CMS-10631 PACE ApplicationForm and Instruction
Form CMS-10631 Waiver Requests (POs)Form and Instruction
Form CMS-10631 PACE ApplicationForm and Instruction
Form CMS-10631 State Readiness Review (States)Form and Instruction
Form CMS-10631 PACE ApplicationForm and Instruction
Form CMS-10631 Support of State Readiness Review (POs)Form and Instruction
Form CMS-10631 PACE ApplicationForm and Instruction
Form CMS-10631 Application Requirements (POs)Form and Instruction
National PACE.pdf (document unavailable)Public Comments
PACE Summary of Changes_Off Cycle PRA_2024.docxSupplementary Document
PACE Summary of Changes_Off Cycle PRA_2024.docx Supplementary Document
CMS-10631 - Supporting Statement_clean.docxSupporting Statement A
CMS-10631 - Supporting Statement_clean.docxSupporting Statement A
Responses to 60-day comments_CMS-10631_102924clean.docxSupplementary Document
Responses to 60-day comments_CMS-10631_102924clean.docx Supplementary Document
Waiver Requests (States) Form and Instruction
Waiver Requests (States) Form and Instruction
Waiver Requests (POs) Form and Instruction
Waiver Requests (POs) Form and Instruction
State Readiness Review (States) Form and Instruction
State Readiness Review (States) Form and Instruction
Support of State Readiness Review (POs) Form and Instruction
Support of State Readiness Review (POs) Form and Instruction
Application Requirements (POs) Form and Instruction
Application Requirements (POs) Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202411-0938-003 Revision of a currently approved collection 2024-11-12
202204-0938-003 Revision of a currently approved collection 2022-05-03 Approved without change
202002-0938-002 Revision of a currently approved collection 2020-02-11 Approved with change
201802-0938-007 Revision of a currently approved collection 2018-03-01 Approved with change
201610-0938-001 New collection (Request for a new OMB Control Number) 2016-10-06 Approved with change

OMB Details

Application Requirements (POs)

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form CMS-10631PACE ApplicationFillable PrintableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.