Information Collection

PQRS Data Validation Project Electronic Survey

IC 213102 under ICR 201409-0938-008 · OMB 0938-1255.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1255 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10519 PQRS Data Validation Project Electronic Survey Form and Instruction
CMS-10519 PQRS Data Validation Electronic Survey PQRS Data Validation Electronic Survey - Att-D-Survey_v1.1.docx Form and Instruction
PQRS Data Validation Electronic Survey - Att-C-Recruitment_v1.1.docx Recruitment documents IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PQRS Data Validation Project Electronic Survey	Agency IC Tracking Number:

Is this a Common Form? No		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-10519	PQRS Data Validation Electronic Survey	PQRS Data Validation Electronic Survey - Att-D-Survey_v1.1.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 115	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	115	115
Annual IC Time Burden (Hours)	173	173
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment documents	PQRS Data Validation Electronic Survey - Att-C-Recruitment_v1.1.docx	09/12/2014

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