Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
AM (Assumptions Document) Modified 1589 3178 0 Form and Instruction CMS-10495
AM (Attestation) Unchanged 1827 6416 0 Form and Instruction CMS-10495
AM (Data Collection and Submission) Modified 2473 1726662 0 Form and Instruction CMS-10495
Form and Instruction CMS-10495
AM (Record Retention) Modified 1589 1589 0 Instruction
AM (Registration) Modified 1589 1589 0 Form and Instruction CMS-10495
Applicable GPO (Assumptions Document) Unchanged 23 46 0 Form and Instruction CMS-10495
Applicable GPO (Attestation) Unchanged 38 100 0 Form and Instruction CMS-10495
Applicable GPO (Data Collection and Submission) Modified 48 306 0 Form and Instruction CMS-10495
Form and Instruction CMS-10495
Applicable GPO (Record Retention) Unchanged 23 23 0 Instruction
Applicable GPO (Registration) Unchanged 23 23 0 Form and Instruction CMS-10495
Dispute Resolution and Correction (AM) Modified 1589 19656 0 Form and Instruction CMS-10495
Form and Instruction CMS-10495
Dispute Resolution and Correction (Physicians) Unchanged 31897 114510 0 Form and Instruction CMS-10495
Form and Instruction CMS-10495
Dispute and Resolution Correction (Teaching Hospitals) Unchanged 2404 38552 0 Form and Instruction CMS-10495
Form and Instruction CMS-10495
GPO Dispute and Resolution Correction Unchanged 23 285 0 Form and Instruction CMS-10495
Form and Instruction CMS-10495
Physicians (Registration) Unchanged 31897 31897 0 Form and Instruction CMS-10495
Teaching Hospitals (Registration) Unchanged 1202 1202 0 Form and Instruction CMS-10495
Total burden requested under this ICR: 78234 1946034 0  
To view an IC, click on IC Title