Tracking the Adoption of Alternative Payment Models (CMS-10620)

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⚠️ Notice: This information collection may be referencing outdated material.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 Tracking the Adoption of Alternative Payment Models (CMS-10620) Form and Instruction
CMS-10620 National Data Collection Metric National_Data_Collection_Metric_508c.pdf Form and Instruction
CMS-10620 National Data Collection Metrics - Excel National_Data_Collection_Metrics_Clean_05.04.17 CAMH DRAFT.xlsx Form and Instruction
CMS-10620 GenIC 13 - Supporting Statement - 2017 05172017.docx CMS-10620 GenIC 13 Suppporting Statement IC Document
National_APM_Metric_Overview_05112017_c508c.pdf National APM Metric Overview IC Document
2017 Frequently Asked Questions 508c.pdf Frequently asked questions IC Document
2017 PRA Application - Burden Hours Response - CMMI.docx Burden Hours Explanation IC Document

Information Collection (IC) Details

IC Title:	Tracking the Adoption of Alternative Payment Models (CMS-10620)	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 Metric	National_Data_Collection_Metric_508c.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10620	National Data Collection Metrics - Excel	National_Data_Collection_Metrics_Clean_05.04.17 CAMH DRAFT.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 10

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	50	50
Annual IC Time Burden (Hours)	1,150	1,150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10620 GenIC 13 Suppporting Statement	CMS-10620 GenIC 13 - Supporting Statement - 2017 05172017.docx	06/06/2017
National APM Metric Overview	National_APM_Metric_Overview_05112017_c508c.pdf	06/06/2017
Frequently asked questions	2017 Frequently Asked Questions 508c.pdf	06/06/2017
Burden Hours Explanation	2017 PRA Application - Burden Hours Response - CMMI.docx	06/27/2017

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