Information Collection

Outcome Metrics - Annual Report

IC 208344 under ICR 201411-0938-005 · OMB 0938-1119.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1119 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10371 Outcome Metrics - Annual Report	Form and Instruction
CMS-10371 Outcome Metrics - Annual Report CMS-10371 - Data Elements Startup Outcomes Metrics Annual_508.pdf	Form and Instruction
CMS-10371 Outcome Metric – SBM Exchange Metrics 0938-1119. (Outcome Metric) SBM Exchange Metrics 20130829 pg layout.xlsx	Form and Instruction

IC Title:

Outcome Metrics - Annual Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Form and Instruction	CMS-10371	Outcome Metrics - Annual Report	CMS-10371 - Data Elements Startup Outcomes Metrics Annual_508.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10371	Outcome Metric â SBM Exchange Metrics	0938-1119. (Outcome Metric) SBM Exchange Metrics 20130829 pg layout.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	640	640
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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