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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form CMS-10620 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

Information Collection (IC) Details

View Information Collection (IC)

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	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 %

	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

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.