Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
AM (Assumptions Document) Unchanged 1572 3144 0 Form and Instruction CMS-10495 Assumptions
AM (Attestation) Unchanged 1572 6288 0 Form and Instruction CMS-10495 Attestation
AM (Data Collection and Submission) Unchanged 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) Unchanged 1572 1572 0 Instruction
AM (Registration) Unchanged 1572 1572 0 Form and Instruction CMS-10495 Registration
Applicable GPO (Assumptions Document) Unchanged 23 46 0 Form and Instruction CMS-10495 Assumptions
Applicable GPO (Attestation) Unchanged 23 92 0 Form and Instruction CMS-10495 Attestation
Applicable GPO (Data Collection and Submission) Unchanged 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) Unchanged 23 23 0 Instruction
Applicable GPO (Registration) Unchanged 23 23 0 Form and Instruction CMS-10495 Registration
Disallowing Record Deletion Without Reason: AM and Applicable GPO Data Collection and Submission New 40 80 0 Form and Instruction CMS-10495 User Guide for Reporting Entities
Dispute Resolution and Correction (AM) Unchanged 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) Unchanged 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 Unchanged 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 Unchanged 1600 13662 0
Optional Annual Recertification: AM and Applicable GPO Attestations New 240 120 0 Form CMS-10495 Attestation and Assumptions
Physicians (Registration) Unchanged 31897 31897 0 Form and Instruction CMS-10495 Registration
Remove General Ownership Records: AM and Applicable GPO Data Collection and Submission New 92 276 0 Form and Instruction CMS-10495 User Guide for Reporting Entities
Standardizing Data on Reported Products Unchanged 1600 51577 0
Teaching Hospital Contact Field: Dispute Resolution and Correction (Teaching Hospitals) New 1996 772 0 Form CMS-10495 Dispute Resolution and Correction
Teaching Hospitals (Registration) Unchanged 1124 1124 0 Form and Instruction CMS-10495 Registration
Updated Contact Information: AM and Applicable GPO Attestations New 30 15 0 Form CMS-10495 Attestation and Assumptions
Total burden requested under this ICR: 81210 1899053 0  
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