Information Collection

PQRS - Claims

IC 201581 under ICR 201211-0938-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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-N - DRAFT 2013_CMS_EHR_QRDA_Da
O - 2013_CMS_EHR_QRDA_Header_Error_Edits_04202012.xlsx	Other-O - 2013_CMS_EHR_QRDA_Header_E
C - DRAFT_2013_EHR_MeasureSpecifications_ReleaseNotes_3_21_2012_v4.0.pdf C - DRAFT_2013_EHR_MeasureSpecifications_ReleaseNotes_3_21_2012_v4	IC Document
D - DRAFT_2013_EHR_MeasureSpecifications_03_21_2012_v4.0.pdf D - DRAFT_2013_EHR_MeasureSpecifications_03_21_2012_v4	IC Document
K - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4.0.pdf K - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4	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	IC Document
P - 2013_CMS_EHR_QRDA_Body_Error_Edits_04252012.xlsx P - 2013_CMS_EHR_QRDA_Body_Error_Edits_04252012	IC Document

IC Title:

PQRS - Claims

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-N - DRAFT 2013_CMS_EHR_QRDA_Data_Sub_Specs_04252012v4.1			N - DRAFT 2013_CMS_EHR_QRDA_Data_Sub_Specs_04252012v4.1.pdf		Yes	Yes	Fillable Fileable
Other-O - 2013_CMS_EHR_QRDA_Header_Error_Edits_04202012			O - 2013_CMS_EHR_QRDA_Header_Error_Edits_04202012.xlsx		Yes	Yes	Fillable Fileable

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: 320,000

Number of Respondents for Small Entity: 320,000

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	320,000	-8,520,000	8,840,000
Annual IC Time Burden (Hours)	3,327,309	1,005,475	2,321,834
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
C - DRAFT_2013_EHR_MeasureSpecifications_ReleaseNotes_3_21_2012_v4	C - DRAFT_2013_EHR_MeasureSpecifications_ReleaseNotes_3_21_2012_v4.0.pdf	10/12/2012
D - DRAFT_2013_EHR_MeasureSpecifications_03_21_2012_v4	D - DRAFT_2013_EHR_MeasureSpecifications_03_21_2012_v4.0.pdf	10/12/2012
K - DRAFT_2013_EHR_DownloadableResourceTable_ReleaseNotes_3_21_2012_v4	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	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.