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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.