Reporting

QECP Annual Report Workbook Submission Requirement and QE DUA and Non-public Analyses Agreement Requirement for Qualified Entities under ACA Section 10332 and MACRA Section 105 (CMS-10589)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1309 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10589 Reporting Form and Instruction
CMS-10589 QECP Annual Report Workbook Copy of QECP_2015_Annual_Report_Workbook_2015_10_16.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	Reporting	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 401.719(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10589	QECP Annual Report Workbook	Copy of QECP_2015_Annual_Report_Workbook_2015_10_16.xlsx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	750	750
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.