View Information Collection (IC)

View Information Collection (IC)

IC Title:	Quality Improvement Strategy Implementation Plan and Progress Report Form (New Issuer)	Agency IC Tracking Number:	10540

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 156.1300 45 CFR 156.200(h) 45 CFR 156.200(b)(5)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10540	QIS-Implementation-Plan	CMS-10540 - Implementation_Plan_Form_v5.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	cms-10540	Modification Summary Supplement	CMS-10540 - Modification_Summary_Supplement_Form_v5.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10540	QIS Progress Report	CMS-10540 - Progress_Report_Form_v5.pdf		Yes	Yes	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: 50	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: 0 %

	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	50	0	0	-200	250	0
Annual IC Time Burden (Hours)	4,000	0	0	-7,000	11,000	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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