Information Collection List

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