HEDIS Information Collection Request (CMS-10219)

Healthcare Effectiveness Data and Information Set (HEDIS) Data Collection for Medicare Advantage

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1028 can be found here:

Documents and Forms

Document Name Document Type
Attachment 1 - HEDIS 2010 - MA HEDIS Measure Specs.pdf Instruction
Attachment 2 - HEDIS Measures 2010 Technical Specifications.pdf Other-Technical Specifications
HEDIS 2010 Reporting MeasuresFINAL with disclosure statement 5-28-2010.pdf HEDIS 2010 Reporting MeasuresFINAL with disclosure statement 5-28-2010 IC Document

Information Collection (IC) Details

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
Instruction			Attachment 1 - HEDIS 2010 - MA HEDIS Measure Specs.pdf		Yes	Yes	Printable Only
Other-Technical Specifications			Attachment 2 - HEDIS Measures 2010 Technical Specifications.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 483	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 Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	483	0	-222	705
Annual IC Time Burden (Hours)	154,560	0	120,720	33,840
Annual IC Cost Burden (Dollars)	7,245,000	7,245,000	0	0

Documents for IC

Title	Document	Date Uploaded
HEDIS 2010 Reporting MeasuresFINAL with disclosure statement 5-28-2010	HEDIS 2010 Reporting MeasuresFINAL with disclosure statement 5-28-2010.pdf	09/09/2010

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