Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
AM (Assumptions Document) Modified 1572 3144 0 Form and Instruction CMS-10495 Assumptions
AM (Attestation) Modified 1572 6288 0 Form and Instruction CMS-10495 Attestation
AM (Data collection and submission) Modified 1572 1639612 0 Instruction
AM (Record Retention) Modified 1572 1572 0 Instruction
AM (Registration) Modified 1572 1572 0 Form and Instruction CMS-10495 General Research Ownership
Form and Instruction CMS-10495 Registration – Physicians & Teaching Hospitals, Applicable Manufacturers and Group Purchasing Organizations
AM Dispute Resolution and Correction New 1572 19446 0 Form and Instruction CMS-10495 Review and Dispute
Applicable GPO (Assumptions Document) New 23 46 0 Form and Instruction CMS-10495 Attestation and Assumptions
Applicable GPO (Attestation) New 23 92 0 Form and Instruction CMS-10495 Attestation and Assumptions
Applicable GPO (Data collection and submission) New 23 216 0 Instruction
Applicable GPO (Record Retention) New 23 23 0 Instruction
Applicable GPO (Registration) New 23 23 0 Form and Instruction CMS-10495 Registration
Form and Instruction CMS-10495 General Research Ownership
Applicable GPO Dispute and Resolution Correction New 23 285 0 Form and Instruction CMS-10495 Review and Dispute
Dispute Resolution and Correction (Physicians) Modified 31897 114510 0 Form and Instruction CMS-10495 Dispute Resolution and Correction
Dispute and Resolution Correction (Teaching Hospitals) Modified 1124 12701 0 Form and Instruction CMS-10495 Dispute Resolution and Correction
Modifying Nature of Payment Categories New 1600 13662 0
Physicians (Registration) Modified 31897 31897 0 Form and Instruction CMS-10495 Physician Registration
Form and Instruction CMS-10495 General Research Ownership
Standardizing Data on Reported Products New 1600 51577 0
Teaching Hospitals (Registration) Modified 1124 1124 0 Form and Instruction CMS-10495 Teaching Hospitals Registration
Form and Instruction CMS-10495 General Research Ownership
Total burden requested under this ICR: 78812 1897790 0  
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