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View Information Collection (IC)
View Information Collection (IC)
IC Title:
Quality Improvement of IPPTA Processes and Procedures
Agency IC Tracking Number:
10894
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
45 CFR 155.1500-1515
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10894
Preparation: SMEs for IPPTA
Workstream 1_ Prepare SBEs for IPPTA.html
https://forms.office.com/Pages/ResponsePage.aspx?id=we3c-6lwS0G_pcMGP8M5XsTeH2nprjVNtlV_jBxTcVtUREFXV0lQWUhOM0YxOUpIOVhBU1c5MlJQTy4u
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10894
Data documentation Submission and Sampling
Workstream 2_ Data Documentation Submission and Sampling.html
https://forms.office.com/Pages/ResponsePage.aspx?id=we3c-6lwS0G_pcMGP8M5XsTeH2nprjVNtlV_jBxTcVtUNjVZU1BNT0tTTDJQT0lTS0Y1QlkwNTUwQi4u
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10894
Conduct Reviews
Workstream 3_ Conduct Reviews.html
https://forms.office.com/Pages/ResponsePage.aspx?id=we3c-6lwS0G_pcMGP8M5XsTeH2nprjVNtlV_jBxTcVtURTlTTFBCSUlONVRYNkc2SEVPWVJBNTU4Ny4u
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10894
Observation and Collaboration
Workstream 4_ Observation and Collaboration.html
https://forms.office.com/Pages/ResponsePage.aspx?id=we3c-6lwS0G_pcMGP8M5XsTeH2nprjVNtlV_jBxTcVtURDBVUEhRT0VLQzZXRVNFT1FNMTkwVU5VNS4u
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10894
SBE Closeout
Workstream 5_ SBE Closeout.html
https://forms.office.com/Pages/ResponsePage.aspx?id=we3c-6lwS0G_pcMGP8M5XsTeH2nprjVNtlV_jBxTcVtURElIMDEwSVhaVFhIV0o5TjdVV1lNVTc1OS4u
Yes
Yes
Fillable Fileable
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:
19
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
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
19
0
19
0
0
0
Annual IC Time Burden (Hours)
228
0
228
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
IPPTA Fast Track Summary
CMS-10894 - IPPTA Form_Fast Track.docx
03/25/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.