Information Collection

GPRO Web Interface Reporting Mechanism

IC 201580 under ICR 201511-0938-008 · OMB 0938-1059.

Documents and Forms

Document Name Document Type
2016_PQRS_ImplementationGuide.pdf Instruction
2015-2016_PQRS ImplementationGuide- Crosswalk.xlsx Other-Crosswalk - Implementation Gui
CMS-10276 Self Nomination Screen Shot - Self-nomination Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	GPRO Web Interface Reporting Mechanism	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 414.90 42 CFR 414.92

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			2016_PQRS_ImplementationGuide.pdf	Yes	Yes	Printable Only
Other-Crosswalk - Implementation Guide			2015-2016_PQRS ImplementationGuide- Crosswalk.xlsx	No		Printable Only
Form	CMS-10276	Self Nomination	Screen Shot - Self-nomination Form.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Performance Measurement and Reporting System	FR Citation: 72 FR 52133

Number of Respondents: 500	Number of Respondents for Small Entity: 200

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	Previously Approved
Annual Number of Responses for this IC	500	300	200
Annual IC Time Burden (Hours)	42,500	25,500	17,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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