Information Collection

414.1375 Advancing Care Information Performance Category - Call for Measures

IC 229074 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10621 414.1375 Advancing Care Information Performance Category - Call for Measures	Form and Instruction
Appendix J Peer Reviewed Journal Article Requirement.docx	Instruction
CMS-10621 ACI Call for Measures Submission Form Appendix F All-Payer QP Data Submission Form (07-02-18).docx	Form and Instruction
CMS-10621 Promoting Interoperability Performance Category (Call fo Appendix H PI Measures Submission Form 2020.docx	Form and Instruction

IC Title:

414.1375 Advancing Care Information Performance Category - Call for Measures

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.1375

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10621	Promoting Interoperability Performance Category (Call for Measures Submission Form)	Appendix H PI Measures Submission Form 2020.docx	Yes	Yes	Fillable Fileable
Instruction			Appendix J Peer Reviewed Journal Article Requirement.docx	No		Printable Only
Form and Instruction	CMS-10621	ACI Call for Measures Submission Form	Appendix F All-Payer QP Data Submission Form (07-02-18).docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 47

Number of Respondents for Small Entity: 47

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
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	47	7	40
Annual IC Time Burden (Hours)	24	4	20
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.