Information Collection

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

IC 221558 under ICR 201509-0938-006 · OMB 0938-1297.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.