View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Health Care Provider Feedback on Open Payments National Transparency Program (Open Payments) - (CMS-10826)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10826	CMS-10826.Recruitment Guide – Teaching Hospital Representatives (revised).docx	CMS-10826.Recruitment Guide – Teaching Hospital Representatives (revised).docx		Yes	No	Fillable Fileable
Form and Instruction	CMS-10826	CMS-10826.Recruitment Guide for Physicians and Other Health Care Providers	CMS-10826.Recruitment Guide for Physicians and Other Health Care Providers (revised).docx		Yes	No	Fillable Fileable
Form and Instruction	CMS-10826	CMS-10826.Health Care Providers (Primary Care and Specialist)	CMS-10826.Health Care Providers (Primary Care and Specialist).docx		Yes	No	Fillable Fileable
Form and Instruction	CMS-10826	CMS-10826.Users-Checked Data (Physicians and Teaching Hospitals) (revised)	CMS-10826.Users-Checked Data (Physicians and Teaching Hospitals) (revised).docx		Yes	No	Fillable Fileable

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: 138	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	138	0	138	0	0	0
Annual IC Time Burden (Hours)	44	0	44	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10826. Database Examples (supplementary) (revised)	CMS-10826. Database Examples (supplementary) (revised).docx	08/01/2023
CMS-10826. Generic Clearance Supporting Statement - Providers (revised)	CMS-10826. Generic Clearance Supporting Statement - Providers (revised).docx	08/01/2023

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