Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
$414.1430 (Partial Qualifying APM Participant (QP) election) Unchanged 17 4 0
414.1330 (Quality Performance Category) Call for Measures Unchanged 40 20 0 Form and Instruction CMS-10621 Data Template for Candidate Measures
414.1375 Advancing Care Information Performance Category - Call for Measures Unchanged 40 20 0 Form and Instruction CMS-10621 ACI Call for Measures Submission Form
414.1445 Other Payer Advanced APM Determininations: Medicaid Specific Clinician Initiated Process Unchanged 75 750 0
§414.1330 and §414.1335 CMS Web Interface Submission Mechanism Unchanged 296 21904 0 Instruction
§414.1330 and §414.1335 Claims Submission Mechanism Unchanged 278039 4949094 0
§414.1330 and §414.1335 EHR Submission Mechanism Unchanged 54218 487962 0
§414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Unchanged 107217 973852 0
§414.1330 and §414.1335 Quality Performance Category) Registration and Enrollment for CMS Web Interface Unchanged 10 10 0
§414.1360 (Improvement Activities Performance Category) Call for Activities Unchanged 150 75 0
§414.1360 (Improvement Activities) Unchanged 439786 439786 0
§414.1375 (Advancing Care Information Performance Category) Unchanged 218215 654645 0
§414.1375 (Advancing Care Information Performance Category) Significant Hardships, including for small practices and decertification of EHRs Unchanged 40645 20323 0
§414.1395 (Physician Compare) Opt Out for Voluntary Participants Unchanged 22400 5600 0
§414.1400 QCDR and qualified registry self nomination Unchanged 233 2330 0
§414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process Modified 300 3000 0 Form and Instruction CMS-10621 Clinician Initiated Submission Form
Form and Instruction CMS-10621 Payer Initiated Submission Form
Total burden requested under this ICR: 1161681 7559375 0  
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