Information Collection

EHR-based Reporting Mechanism

IC 211746 under ICR 201511-0938-008 · OMB 0938-1059.

Documents and Forms

Document Name Document Type
2015_PQRS_ImplementationGuide.pdf Instruction
2015-2016_PQRS ImplementationGuide- Crosswalk.xlsx Other-Crosswalk - Implementation Gui

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EHR-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			2015_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: 50,000	Number of Respondents for Small Entity: 50,000

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50,000	50,000
Annual IC Time Burden (Hours)	450,000	450,000
Annual IC Cost Burden (Dollars)	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.