HEDIS Information Collection Request

HEDIS Data Collection for Medicare Advantage (CMS-10219)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1028 can be found here:

Documents and Forms

Document Name Document Type
HEDIS 2013 Volume 3.09.21.12.zip Other-HEDIS 2013 Volume 3: Specifica
Updated hedis hos cahps 2013_20120801.pdf Memo - Updated Requirements for Reporting of 2013 Measures IC Document
HEDIS 2013 Volume 5.10.31.12.zip HEDIS 2013 Volume 5, Compliance Audit -- Standards, Policies and Procedures IC Document

Information Collection (IC) Details

IC Title:	HEDIS Information Collection Request	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.152

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HEDIS 2013 Volume 3: Specifications for Survey Measures			HEDIS 2013 Volume 3.09.21.12.zip		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 515	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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	515	-58	573
Annual IC Time Burden (Hours)	164,800	-19,520	184,320
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Memo - Updated Requirements for Reporting of 2013 Measures	Updated hedis hos cahps 2013_20120801.pdf	08/27/2013
HEDIS 2013 Volume 5, Compliance Audit -- Standards, Policies and Procedures	HEDIS 2013 Volume 5.10.31.12.zip	08/27/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.