View Information Collection (IC)

View Information Collection (IC)

Application and Re-application processes
 
No Modified
 
Voluntary
 
42 CFR 401.703a

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10394 Application PaperBased_Application_Form_09292016.pdf Yes Yes Fillable Fileable Signable
Form and Instruction CMS-10394 QECP Measure Production QA Worksheet QECP_QA_Worksheet_8_16_2017.pdf Yes Yes Fillable Fileable Signable
Form and Instruction CMS-10394 QECP Measure Information Workbook QECP_Measure_Information_Workbook_8_16_20171.pdf Yes Yes Fillable Fileable Signable
Instruction QECP Letter of Commitment Template.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10394 QECP Data Source Attestation QECP_Data_Source_Attestation1.pdf Yes Yes Fillable Fileable Signable
Form and Instruction CMS-10394 QECP Data Security Workbook QECP Data Security Workbook-blank-11-131.pdf Yes Yes Fillable Fileable Signable
Instruction QECP Letter of Commitment Template_Quasi QE.pdf Yes Yes Fillable Printable

Health Health Care Services

 

10 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10 0 -25 0 35 0
Annual IC Time Burden (Hours) 5,000 0 -1,833 0 6,833 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.