Initial Application

Application to Be a Qualified Entity to Receive Medicare Data for Performance Measurement

OMB: 0938-1144

IC ID: 198017

Information Collection (IC) Details

View Information Collection (IC)

Initial Application
 
No New
 
Voluntary
 
42 CFR 401.7039(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10392 Qualified Entity Application CMS-10394.Draft_QE_Application.pdf Yes No Fillable Fileable
Form and Instruction CMS-10394 Revised QE Application CMS-10394.REVISED QE Application(8-8-11).docx Yes No Fillable Fileable

Health Health Care Services

 

35 35
   
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 35 35 0 0 0 0
Annual IC Time Burden (Hours) 17,500 17,500 0 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.

© 2024 OMB.report | Privacy Policy