Information Collection

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

IC 227104 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

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 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 %

table that charts list of burden
	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

table that charts IC Documents
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.