Information Collection

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

IC 230265 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⚠️ Notice: This information collection may be referencing outdated material.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 National Data Collection Metrics Tracking the Adoption of Alternative Payment Models (CMS-10620)	Form and Instruction
Form CMS-10620 APM Survey Tracking the Adoption of Alternative Payment Models (CMS-10620)	Form and Instruction
Form CMS-10620 Informational Questions Tracking the Adoption of Alternative Payment Models (CMS-10620)	Form and Instruction
CMS-10620 National Data Collection Metrics National_Data_Collection_Metrics_2018.xlsx	Form and Instruction
CMS-10620 APM Survey 2018 APM survey - qualtrics 31jan2018.pdf	Form and Instruction
CMS-10620 Informational Questions Informational Questions_2.2.2018.docx	Form and Instruction
CMS-10620 GenIC - 13 Supporting Statement - revised - 2.26.2018.docx CMS-10620 GenIC 13 Supporting Statement	IC Document
2018 Burden Estimate_2.2.2018.docx Current Burden Estimate	IC Document
2018 APM Burden Hours Appendix - 2.2.2018.docx Change in Burden Hours	IC Document
2018 National APM Metric Overview - 2.2.2018.docx National Metric Overview	IC Document
APM Measurement Frequently Asked Questions_2.2.2018.docx APM Measuremen FAQ	IC Document
Updates for the 2018 LAN Measurement page.docx LAN Measurement page	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10620	National Data Collection Metrics	National_Data_Collection_Metrics_2018.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10620	APM Survey	2018 APM survey - qualtrics 31jan2018.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10620	Informational Questions	Informational Questions_2.2.2018.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 15

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	75	75
Annual IC Time Burden (Hours)	1,875	1,875
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 - revised - 2.26.2018.docx	02/27/2018
Current Burden Estimate	2018 Burden Estimate_2.2.2018.docx	02/27/2018
Change in Burden Hours	2018 APM Burden Hours Appendix - 2.2.2018.docx	02/27/2018
National Metric Overview	2018 National APM Metric Overview - 2.2.2018.docx	02/27/2018
APM Measuremen FAQ	APM Measurement Frequently Asked Questions_2.2.2018.docx	02/27/2018
LAN Measurement page	Updates for the 2018 LAN Measurement page.docx	02/27/2018

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