Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
AM (Assumptions Document) Modified 1768 3536 0 Form and Instruction CMS-10495 Assumptions
AM (Attestation) Modified 2055 7217 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) Modified 1768 1768 0 Instruction
AM (Registration) Modified 1768 1768 0 Form and Instruction CMS-10495 Registration
Applicable GPO (Assumptions Document) Modified 20 40 0 Form and Instruction CMS-10495 Assumptions
Applicable GPO (Attestation) Modified 33 87 0 Form and Instruction CMS-10495 Attestation
Applicable GPO (Data Collection and Submission) Modified 42 268 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) Modified 20 20 0 Instruction
Applicable GPO (Registration) Modified 20 20 0 Form and Instruction CMS-10495 Registration
Dispute Resolution and Correction (AM) Modified 1768 21871 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 2183 7837 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 4316 69214 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 25 310 0 Form and Instruction CMS-10495 Review and Dispute Screen Shots
Form and Instruction CMS-10495 Review and Dispute Email Notifications
Physicians (Registration) Modified 31994 31994 0 Form and Instruction CMS-10495 Registration
Teaching Hospitals (Registration) Modified 1227 1227 0 Form and Instruction CMS-10495 Registration
Total burden requested under this ICR: 51480 1873839 0  
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