View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	HEDIS Information Collection Request (CMS-10219)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.152

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HEDIS 2013 Volume 3: Specifications for Survey Measures			HEDIS 2013 Volume 3.09.21.12.zip		Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 573	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	573	0	0	90	0	483
Annual IC Time Burden (Hours)	184,320	0	0	29,760	0	154,560
Annual IC Cost Burden (Dollars)	0	0	0	-7,245,000	0	7,245,000

Documents for IC

Title	Document	Date Uploaded
HEDIS 2013 and HEDIS 2010 Crosswalk for PRA package 8-27-13	HEDIS 2013 and HEDIS 2010 Crosswalk for PRA package 8-27-13.docx	08/27/2013
Memo - Updated Requirements for Reporting of 2013 Measures	Updated hedis hos cahps 2013_20120801.pdf	08/27/2013
HEDIS 2013 Volume 5, Compliance Audit -- Standards, Policies and Procedures	HEDIS 2013 Volume 5.10.31.12.zip	08/27/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.