Information Collection

§414.1400 QCDR and qualified registry self nomination

IC 221782 under ICR 201808-0938-005 · OMB 0938-1314.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1314 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A_QPP_Qualified_Registry_Self-Nomination_Fact_Sheet.pdf Qualified Registry Self Nomination Fact Sheet	IC Document
Appendix B_QPP_QCDR_Self-Nomination_Fact_Sheet.pdf QCDR Self Nomination Fact Sheet	IC Document

IC Title:

§414.1400 QCDR and qualified registry self nomination

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR §414.1400 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 233

Number of Respondents for Small Entity: 233

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	233	233
Annual IC Time Burden (Hours)	2,330	2,330
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Qualified Registry Self Nomination Fact Sheet		11/17/2017
QCDR Self Nomination Fact Sheet		11/17/2017

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

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