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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.