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 Form and Instruction CMS-10495 Open Payments User Guide
Form and Instruction CMS-10495 General-Research-Ownership Submission Data Elements and Screen Shots
AM (Record Retention) Modified 1572 1572 0 Instruction
AM (Registration) Modified 1572 1572 0 Form and Instruction CMS-10495 Registration
Applicable GPO (Assumptions Document) New 23 46 0 Form and Instruction CMS-10495 Assumptions
Applicable GPO (Attestation) New 23 92 0 Form and Instruction CMS-10495 Attestation
Applicable GPO (Data Collection and Submission) New 23 216 0 Form and Instruction CMS-10495 Open Payments User Guide
Form and Instruction CMS-10495 General-Research-Ownership Submission Data Elements Screen Shots
Applicable GPO (Record Retention) New 23 23 0 Instruction
Applicable GPO (Registration) New 23 23 0 Form and Instruction CMS-10495 Registration
Dispute Resolution and Correction (AM) New 1572 19446 0 Form and Instruction CMS-10495 Review and Dispute Screen Shots
Form and Instruction CMS-10495 Review and Dispute Email Notifications
Dispute Resolution and Correction (Physicians) Modified 31897 114510 0 Form and Instruction CMS-10495 Review and Dispute Screen Shots
Form and Instruction CMS-10495 Review and Dispute Email Notifications
Dispute and Resolution Correction (Teaching Hospitals) Modified 1124 12701 0 Form and Instruction CMS-10495 Review and Dispute Screen Shots
Form and Instruction CMS-10495 Review and Dispute Email Notifications
GPO Dispute and Resolution Correction New 23 285 0 Form and Instruction CMS-10495 Review and Dispute Screen Shots
Form and Instruction CMS-10495 Review and Dispute Email Notifications
Modifying Nature of Payment Categories New 1600 13662 0
Physicians (Registration) Modified 31897 31897 0 Form and Instruction CMS-10495 Registration
Standardizing Data on Reported Products New 1600 51577 0
Teaching Hospitals (Registration) Modified 1124 1124 0 Form and Instruction CMS-10495 Registration
Total burden requested under this ICR: 78812 1897790 0  
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