HEDIS Information Collection Request

HEDIS Information Collection Request

OMB: 0938-1028

IC ID: 181326

Documents and Forms
Document Name
Document Type
Form
Other-Appendices
Instruction
Instruction
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

HEDIS Information Collection Request
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10219 CMS-10219.2_Effectiveness of Care A_pp 55-111 CMS-10219.2_Effectiveness of Care A_pp 55-111.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.1_General Guidelines_ CMS-10219.1_General Guidelines_to p 54.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.3_Effectiveness of Care B_pp 112-178 CMS-10219.3_Effectiveness of Care B_pp 112-178.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.4_Access-Availability of Care_pp 179-210. CMS-10219.4_Access-Availability of Care_pp 179-210.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.5_Satisfaction with Care_pp 211-216. CMS-10219.5_Satisfaction with Care_pp 211-216.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.6_Health Plan Stability_pp 217-220 CMS-10219.6_Health Plan Stability_pp 217-220.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.7_Use of Services A_pp 221-270 CMS-10219.7_Use of Services A_pp 221-270.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.8_Use of Services B_pp 271-302 CMS-10219.8_Use of Services B_pp 271-302.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.9_Cost of Care_pp 303-374 CMS-10219.9_Cost of Care_pp 303-374.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.10_Informed Health Care Choices_pp 375-378 CMS-10219.10_Informed Health Care Choices_pp 375-378.doc Yes Yes Fillable Fileable
Form CMS-10219 CMS-10219.11_Health Plan Description_pp 379-406 CMS-10219.11_Health Plan Description_pp 379-406.doc Yes Yes Fillable Fileable
Other-Appendices CMS-10219.12_Appendices 1-2-3-4-5-6-7.doc Yes Yes Fillable Fileable
Instruction CMS-10219.HEDIS 2007 Vol 2 file list.doc Yes Yes Fillable Fileable
Instruction CMS-10219.LICENSEAGREEMENT.doc Yes Yes Fillable Fileable

Health Health Care Services

 

705 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 705 0 705 0 0 0
Annual IC Time Burden (Hours) 33,840 0 33,840 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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