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  
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