Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1023 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10209 CCIP Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project Form and Instruction
CMS-10209 QIP Medicare Advantage Quality Improvement Project Reporting QIP Reporting Template 02-05-07 .doc Form and Instruction
CMS-10209 CCIP Chronic Care Improvement Program Reporting Template CCIP ReportingTemplate 02-05-07.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.152a

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10209 CCIP	Chronic Care Improvement Program Reporting Template	CCIP ReportingTemplate 02-05-07.doc		Yes	Yes	Paper Only
Form and Instruction	CMS-10209 QIP	Medicare Advantage Quality Improvement Project Reporting	QIP Reporting Template 02-05-07 .doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 426	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	852	852
Annual IC Time Burden (Hours)	9,227	9,227
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.