Information Collection

?414.1400 QCDR and qualified registry self nomination

IC 221782 under ICR 201810-0938-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Appendix A 2019-MIPS Qualified Registry Self-Nomination Fact Sheet.docx Qualified Registry Self Nomination Fact Sheet IC Document
Appendix B 2019-MIPS QCDR Self-Nomination Fact Sheet.docx QCDR Self Nomination Fact Sheet IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	§414.1400 QCDR and qualified registry self nomination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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:

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: 350	Number of Respondents for Small Entity: 350

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	350	117	233
Annual IC Time Burden (Hours)	2,850	520	2,330
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Qualified Registry Self Nomination Fact Sheet	Appendix A 2019-MIPS Qualified Registry Self-Nomination Fact Sheet.docx	10/17/2018
QCDR Self Nomination Fact Sheet	Appendix B 2019-MIPS QCDR Self-Nomination Fact Sheet.docx	10/17/2018

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