(CMS-10620) Tracking the adoption of alternative payment models

Generic Clearance for the Heath Care Payment Learning and Action Network (CMS-10575)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1297 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10620 (CMS-10620) Tracking the adoption of alternative payment models Form and Instruction
CMS-10620 National Data Collection Metrics National Data Collection Metrics 051616v4.clean.xlsx Form and Instruction
CMS-10620 GenIC 13 - Supporting Statement - clean.docx CMS-10620 GenIC 13 Supporting Statement IC Document
APM data collection webpage language - draft - v3 - 5.16.16.docx APM webpage language IC Document
National APM Metric Overview - FINAL- cmmi.docx National APM Metric Overview IC Document
Frequently Asked Questions - 051316.docx Frequently Asked Questions IC Document

Information Collection (IC) Details

IC Title:	(CMS-10620) Tracking the adoption of alternative payment models	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-10620	National Data Collection Metrics	National Data Collection Metrics 051616v4.clean.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 440	Number of Respondents for Small Entity: 88

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	440	440
Annual IC Time Burden (Hours)	13,640	13,640
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10620 GenIC 13 Supporting Statement	CMS-10620 GenIC 13 - Supporting Statement - clean.docx	05/17/2016
APM webpage language	APM data collection webpage language - draft - v3 - 5.16.16.docx	05/17/2016
National APM Metric Overview	National APM Metric Overview - FINAL- cmmi.docx	05/17/2016
Frequently Asked Questions	Frequently Asked Questions - 051316.docx	05/17/2016

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