Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
AM and Applicable GPO (Assumptions Document) Modified 4716 9432 0 Form and Instruction CMS-10495 Assumptions
AM and Applicable GPO (Attestation) Modified 4716 18864 0 Form and Instruction CMS-10495 Attestation
AM and Applicable GPO (Data submission) New 1595 37275 0 Form CMS-10495 Open Payments User Guide - Data Submission
AM and Applicable GPO (Record Retention) Modified 3144 1572 0 Instruction
AM and Applicable GPO (Registration) Modified 3144 22008 0 Form and Instruction CMS-10495 AM and AGPO Registration
Dispute Resolution and Correction (Physicians) Modified 31897 146088 0 Form and Instruction CMS-10495 Dispute Resolution and Correction
Dispute and Resolution Correction (Teaching Hospitals) Modified 1124 39340 0 Form and Instruction CMS-10495 Dispute Resolution and Correction
Physicians (Registration) Modified 127588 829322 0 Form and Instruction CMS-10495 Physician Registration
Teaching Hospitals (Registration) Modified 1124 39340 0 Form and Instruction CMS-10495 Teaching Hospitals Registration
Total burden requested under this ICR: 179048 1143241 0  
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