Information Collection

PQRS - Individual EP

IC 201581 under ICR 201203-0938-009 · OMB 0938-1059.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1059 can be found here:

Documents and Forms

Document Name Document Type
N - DRAFT 2013_CMS_EHR_QRDA_Data_Sub_Specs_04252012v4.1.pdf Other-CMS EHR QRDA
O - 2013_CMS_EHR_QRDA_Header_Error_Edits_04202012.xlsx Other-CMS EHR QRDA
A - 2012_PhysQualRptg_MeasuresList_122311.pdf A - 2012_PhysQualRptg_MeasuresList_122311 IC Document
B - 2012_PhysQualRptg_ImplementationGuide_01-13-2012.pdf B - 2012_PhysQualRptg_ImplementationGuide_01-13-2012 IC Document
C - DRAFT_2013_EHR_MeasureSpecifications_ReleaseNotes_3_21_2012_v4.0.pdf C - DRAFT_2013_EHR_MeasureSpecifications_ReleaseNotes_3_21_2012_v4.0 IC Document
D - DRAFT_2013_EHR_MeasureSpecifications_03_21_2012_v4.0.pdf D - DRAFT_2013_EHR_MeasureSpecifications_03_21_2012_v4.0 IC Document
E - DRAFT_2013_EHR_DownloadableResourceTable-032112_v4.0.xlsx E - DRAFT_2013_EHR_DownloadableResourceTable-032112_v4.0 IC Document
F - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4.0.pdf F - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4.0 IC Document
G - 2012_PhysQualRptg_MAV_ReleaseNotes_111011.pdf G - 2012_PhysQualRptg_MAV_ReleaseNotes_111011 IC Document
H - 2012_PhysQualRptg_MAV_ProcessforClaimsBasedReporting_111011.pdf H - 2012_PhysQualRptg_MAV_ProcessforClaimsBasedReporting_111011 IC Document
I - 2012_PhysQualRptg_MAV_Flow_111011.pdf I - 2012_PhysQualRptg_MAV_Flow_111011 IC Document
J - DRAFT_2013_EHR_DownloadableResourceTable-032112_v4.0.xlsx J - DRAFT_2013_EHR_DownloadableResourceTable-032112_v4.0 IC Document
K - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4.0.pdf K - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4.0 IC Document
L - DRAFT 2013_EHR_DownloadableResourceTable_Other_Resource_Codes_Mar_2012.xlsx L - DRAFT 2013_EHR_DownloadableResourceTable_Other_Resource_Codes_Mar_2012 IC Document
M - DRAFT 2013_CMS_EHR_QRDA_Data_Sub_Specs_Release_Notes_04252012_v4.1.pdf M - DRAFT 2013_CMS_EHR_QRDA_Data_Sub_Specs_Release_Notes_04252012_v4.1 IC Document
P - 2013_CMS_EHR_QRDA_Body_Error_Edits_04252012.xlsx P - 2013_CMS_EHR_QRDA_Body_Error_Edits_04252012 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PQRS - Individual EP	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 414.90 42 CFR 414.92

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-CMS EHR QRDA			N - DRAFT 2013_CMS_EHR_QRDA_Data_Sub_Specs_04252012v4.1.pdf		Yes	Yes	Printable Only
Other-CMS EHR QRDA			O - 2013_CMS_EHR_QRDA_Header_Error_Edits_04202012.xlsx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Performance Measurement and Reporting System	FR Citation: 72 FR 52133

Number of Respondents: 228,579	Number of Respondents for Small Entity: 228,579

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
Annual Number of Responses for this IC	8,840,000	8,840,000
Annual IC Time Burden (Hours)	2,321,834	2,321,834
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
A - 2012_PhysQualRptg_MeasuresList_122311	A - 2012_PhysQualRptg_MeasuresList_122311.pdf	10/12/2012
B - 2012_PhysQualRptg_ImplementationGuide_01-13-2012	B - 2012_PhysQualRptg_ImplementationGuide_01-13-2012.pdf	10/12/2012
C - DRAFT_2013_EHR_MeasureSpecifications_ReleaseNotes_3_21_2012_v4.0	C - DRAFT_2013_EHR_MeasureSpecifications_ReleaseNotes_3_21_2012_v4.0.pdf	10/12/2012
D - DRAFT_2013_EHR_MeasureSpecifications_03_21_2012_v4.0	D - DRAFT_2013_EHR_MeasureSpecifications_03_21_2012_v4.0.pdf	10/12/2012
E - DRAFT_2013_EHR_DownloadableResourceTable-032112_v4.0	E - DRAFT_2013_EHR_DownloadableResourceTable-032112_v4.0.xlsx	10/12/2012
F - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4.0	F - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4.0.pdf	10/12/2012
G - 2012_PhysQualRptg_MAV_ReleaseNotes_111011	G - 2012_PhysQualRptg_MAV_ReleaseNotes_111011.pdf	10/12/2012
H - 2012_PhysQualRptg_MAV_ProcessforClaimsBasedReporting_111011	H - 2012_PhysQualRptg_MAV_ProcessforClaimsBasedReporting_111011.pdf	10/12/2012
I - 2012_PhysQualRptg_MAV_Flow_111011	I - 2012_PhysQualRptg_MAV_Flow_111011.pdf	10/12/2012
J - DRAFT_2013_EHR_DownloadableResourceTable-032112_v4.0	J - DRAFT_2013_EHR_DownloadableResourceTable-032112_v4.0.xlsx	10/12/2012
K - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4.0	K - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4.0.pdf	10/12/2012
L - DRAFT 2013_EHR_DownloadableResourceTable_Other_Resource_Codes_Mar_2012	L - DRAFT 2013_EHR_DownloadableResourceTable_Other_Resource_Codes_Mar_2012.xlsx	10/12/2012
M - DRAFT 2013_CMS_EHR_QRDA_Data_Sub_Specs_Release_Notes_04252012_v4.1	M - DRAFT 2013_CMS_EHR_QRDA_Data_Sub_Specs_Release_Notes_04252012_v4.1.pdf	10/12/2012
P - 2013_CMS_EHR_QRDA_Body_Error_Edits_04252012	P - 2013_CMS_EHR_QRDA_Body_Error_Edits_04252012.xlsx	10/12/2012

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