Information Collection

Claims-based Reporting Mechanism (Eligible Professionals)

IC 211744 under ICR 201412-0938-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
2015_PQRS_ImplementationGuide.pdf	Instruction
2015_PQRS_MAV_ProcessforRegistryBasedReporting_01152015.pdf	Instruction

IC Title:

Claims-based Reporting Mechanism (Eligible Professionals)

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
Instruction			2015_PQRS_ImplementationGuide.pdf		Yes	Yes	Printable Only
Instruction			2015_PQRS_MAV_ProcessforRegistryBasedReporting_01152015.pdf		Yes	Yes	Printable Only

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: 250,000

Number of Respondents for Small Entity: 230,000

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
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	250,000	20,000	0	230,000
Annual IC Time Burden (Hours)	3,948,920	2,431,463	315,914	1,201,543
Annual IC Cost Burden (Dollars)	0	0	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.