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Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4)
 
No Modified
 
Mandatory
 
42 CFR ยง414.1400  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Form CMS-10621 Yes Yes Fillable Fileable

Health Health Care Services

 

381 350
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Requested 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 381 0 31 0 0 350
Annual IC Time Burden (Hours) 3,782 0 932 0 0 2,850
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk - 2020 Qualified Registry Fact Sheet 08/21/2019
Crosswalk - 2020 Qualified Clinical Data Registry (QCDR) Fact Sheet 08/21/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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