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Federal forms, ICRs, and supporting documents

Information Collection

Registry or Qualified Clinical Data Registry Vendors (QCDR) (Reporting on Behalf of Eligible Professionals and/or Group Practices)

IC 201578 under ICR 201412-0938-003 · OMB 0938-1059.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Information Collection (IC) Details

View Information Collection (IC)

Registry or Qualified Clinical Data Registry Vendors (QCDR) (Reporting on Behalf of Eligible Professionals and/or Group Practices)
 
No Modified
 
Voluntary
 
42 CFR 414.90 42 CFR 414.92

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction 2015_PQRS_MAV_ProcessforRegistryBasedReporting_01152015.pdf Yes Yes Printable Only
Instruction 2015_PQRS_ImplementationGuide.pdf Yes Yes Printable Only

Health Health Care Services

Performance Measurement and Reporting System  72 FR 52133

150 50
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 150 0 100 0 0 50
Annual IC Time Burden (Hours) 1,500 0 0 1,000 0 500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.