Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
42 CFR 495.10(a) (b) (hospital) (2011) Modified 5011 835 0
42 CFR 495.10(a)-(c) -- (EPs) (2011) average Modified 521600 86933 0
42 CFR 495.10(d) - (EPs) (2012) average Modified 57998 9666 0
42 CFR 495.10(d) - (hospital) (2012) Modified 401 67 0
42 CFR 495.10(e)(1) - (EPs) (2011) average Modified 95500 15917 0
42 CFR 495.10(e)(2) - (EPs) (2012) average Modified 96500 16083 0
42 CFR 495.202(b)(2) (2012) EPs-final ID Modified 12 2 0
42 CFR 495.202(b)(2) (2012) EPs-preliminary ID Modified 12 2 0
42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-final ID Modified 12 1 0
42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-preliminary ID Modified 12 1 0
42 CFR 495.204(b)(2) (2012) Revenue reporting Modified 12 160 0
42 CFR 495.204(b)(4) (2012) EPs-method Modified 2 1 0
42 CFR 495.204(b)(5) or (b)(6)(2012) EPs-salary Modified 12 233 0
42 CFR 495.210(b) (2012) EPs-attestation Modified 12 160 0
42 CFR 495.306(a)(1)(i) Modified 139600 23267 0
42 CFR 495.306(a)(1)(ii)(A) Modified 139600 23267 0
42 CFR 495.306(a)(1)(ii)(B) Modified 139600 23267 0
42 CFR 495.306(a)(2) Modified 4933 822 0
42 CFR 495.316 Modified 56 93 0
42 CFR 495.330(a) - average Modified 56 93 0
42 CFR 495.348(c) Modified 56 9 0
42 CFR 495.348(e) Modified 56 9 0
42 CFR 495.348(f) Modified 56 93 0
42 CFR 495.350--average Modified 56 19 0
42 CFR 495.352 -- average Modified 56 93 0
42 CFR 495.366 -- average Modified 56 93 0
42 CFR 495.8 (a)(1)- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (EPs) (2011) Modified 521600 1628609 0
42 CFR 495.8 (a)(1)- Menu Set Objectives/Measures average (EPs) (2011) Modified 521600 292617 0
42 CFR 495.8 (a)(2)- Ambulatory Quality Measures (EPs) (2012) Modified 527254 87876 0
42 CFR 495.8 (a)(2)- Menu Set Objectives/ Measures average (EPs) (2012) Modified 527254 295789 0
42 CFR 495.8 (b)(1)-- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (hospitals/CAHs) (2011) Modified 5011 23050 0
42 CFR 495.8 (b)(2)- Hospital Quality Measures (hospitals/CAHs) (2012) Modified 5011 835 0
42 CFR 495.8 (b)(2)- Menu Set Objectives/ Measures average (hospitals/CAHs) (2012) Modified 5011 3508 0
42 CFR 495.8 (b)(2)-- EHR Technology Used & Core Set Objectives/Measures (hospitals/CAHs) (2012) Modified 5011 14532 0
42 CFR 495.8(a)(2) - EHR Technology Used & Core Set Objectives/Measures (EPs) (2012) Modified 527254 1558387 0
42 CFR 495.8(b)(1) - Menu Set Objectives/ Measures average (hospitals/CAHs) (2011) Modified 5011 3058 0
495.210 - Attesting on behalf of MA EPs New 13000 1083 0
495.210 - Attesting on behalf of MA-affiliated hospitals New 30 15 0
495.210 - Gather information for attestation (MA EPs) New 13000 3250 0
495.210 - Gather information for attestation (MA-affiliated hospitals) New 30 70 0
495.210 - Total Cost of Attestation for Stage 2 (MA EPs) New 13000 4333 0
495.210 - Total cost of attestation for Stage 2 (MA-affiliated hospitals) New 30 85 0
495.342 - Frequency of Health Information Technology (HIT) Implementation Advanced Planning Document (IAPD) Updates New 56 1307 0
495.6 - EHR Technology Used, Core Set Objectives/Measures (Hospitals/CAHS) New 2696 6965 0
495.6 - Menu Set Objectives/Measures (EPs) average New 198912 18234 0
495.6 - Menu Set Objectives/Measures (Hospitals/CAHs) New 2696 449 0
495.6 EHR Technology Used, Core Set Objectives/Measures (EPs) New 198912 545019 0
495.8 - CQMs for hospitals/CAHS New 2696 2399 0
495.8 - CQMs for hospitals/CAHs New 198912 99456 0
Total burden requested under this ICR: 4495264 4792112 0  
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