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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
QECP Application, Reapplication, DUA and ARW
Modified
70
5800
0
Form and Instruction
CMS-10394
QECP Paper-Based Reapplication Form
Form and Instruction
CMS-10394
Phase 1 Application Readiness Checklist
Form and Instruction
CMS-10394
Phase 2 Application Readiness Checklist
Instruction
Form and Instruction
CMS-10394
Phase 3 Application Readiness Checklist
Form and Instruction
CMS-10394
Qualified Entity Certification Program Data Security Review (QECP DSR)
Form and Instruction
CMS-10394
Letter of Commitment Template
Form and Instruction
CMS-10394
Extension Request Letter
Instruction
Instruction
Form and Instruction
CMS-10394
Public Report Submission Form
Form and Instruction
CMS-10394
QECP Data Source Attestation Workbook
Total burden requested under this ICR:
70
5800
0
To view an IC, click on IC Title