GenIC#10 - Quality Payment Program Provider Awareness Tracking Survey

Generic Social Marketing & Consumer Testing Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1247 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10437.GenIC#10 GenIC#10 - Quality Payment Program Provider Awareness Tracking Survey Form and Instruction
CMS-10437.GenIC#10 Quality Payment Program Provider Awareness Tracking Surv CMS-10437.GenIC#10 - QPPTracker_Survey_FINAL.docx Form and Instruction
CMS-10437.GenIc#10 - QPPTracker_SupportingStatement_FINAL.docx CMS-10437.GenIC#10 - Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	GenIC#10 - Quality Payment Program Provider Awareness Tracking Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10437.GenIC#10	Quality Payment Program Provider Awareness Tracking Survey	CMS-10437.GenIC#10 - QPPTracker_Survey_FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,800	2,800
Annual IC Time Burden (Hours)	700	700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10437.GenIC#10 - Supporting Statement	CMS-10437.GenIc#10 - QPPTracker_SupportingStatement_FINAL.docx	03/23/2017

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