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Federal forms, ICRs, and supporting documents

Information Collection

PQRS Data Validation Project Electronic Survey

IC 213102 under ICR 201602-0938-001 · OMB 0938-1255.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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PQRS Data Validation Project Electronic Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10519 Attachment D - Survey PQRS Data Validation Electronic Survey - Att-D-Survey_OY1_20150126.docx Yes Yes Fillable Fileable

Health Health Care Services

 

115 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 115 0 0 0 0 115
Annual IC Time Burden (Hours) 173 0 0 0 0 173
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment C - Survey Invitation PQRS Data Validation Electronic Survey - Att-C-Recruitment_OY1_20150126.docx 02/09/2016
Primary Source Verification Paper PSV Information Paper - Awareness (Final 06052015).docx 02/09/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.