Information Collection Request

(CMS-10519) Physician Quality Reporting System and the Electronic Prescribing Incentive Program Data Assessment, Accuracy and Improper Payments Identification Support

ICR 201602-0938-001 · OMB 0938-1255 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10519 PQRS Data Validation Project Electronic Survey Form and Instruction Modified Available
CMS-10519 Response_to_Public_Comments.doc Supplementary Document Uploaded 2016-02-09 Available
PQRS Data Validation Electronic Survey - Supporting Statement - Part B_OY1_20150126.docx Supporting Statement B Uploaded 2016-02-09 Available
CMS-10519 PQRS Data Validation Electronic Survey - Supporting Statement A - final.docx Supporting Statement A Uploaded 2016-10-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
213102 PQRS Data Validation Project Electronic Survey Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2019 36 Months From Approved 11/30/2017
115 0 115
173 0 173
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
PQRS Data Validation Project Electronic Survey CMS-10519 Attachment D - Survey

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 115 115 0 0 0 0
Annual Time Burden (Hours) 173 173 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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