OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool ("PAT")

OMB 0938-0941 · HHS/CMS.

OMB 0938-0941

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration Form and Instruction
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) -EHR Demonstration Form and Instruction
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - PGP Demonstration Form and Instruction
Supporting Statement - Part B - PGP TD_062112.docx Supporting Statement B
2Supporting_Statement_-_Part_A_PGPTD.pdf Supporting Statement A
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration Form and Instruction
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) -EHR Demonstration Form and Instruction
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - PGP Demonstration Form and Instruction

All Historical Document Collections

201205-0938-008 Approved with change	Reinstatement without change of a previously approved collection	2012-05-22
201106-0938-013 Withdrawn and continue	Revision of a currently approved collection	2011-06-15
200809-0938-015 Approved with change	Revision of a currently approved collection	2008-09-26
200511-0938-002 Approved with change	Extension without change of a currently approved collection	2005-11-03
200502-0938-006 Approved without change	New collection (Request for a new OMB Control Number)	2005-02-18