Information Collection

Claims-based Reporting Mechanism

IC 211744 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claims-based 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	URL	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

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: 350,000	Number of Respondents for Small Entity: 230,000

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	350,000	100,000	250,000
Annual IC Time Burden (Hours)	5,528,488	1,579,568	3,948,920
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.