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Federal forms, ICRs, and supporting documents

Information Collection

QualityNet Identity Management System (QIMS) Account Form (Subsequent Years)

IC 186127 under ICR 201109-0938-007 · OMB 0938-1050.

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

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QualityNet Identity Management System (QIMS) Account Form (Subsequent Years)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10267 QIMS- Account Registration Form CMS-10267.QIMS-CW_Account Registration_Form 8-8(final).docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,600 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 1,600 0 0 0 0 1,600
Annual IC Time Burden (Hours) 800 0 0 0 0 800
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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