Information Collection

414.1330 (Quality Performance Category) Call for Measures

IC 229086 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⚠️ Notice: This information collection may be referencing outdated material.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 414.1330 (Quality Performance Category) Call for Measures	Form and Instruction
Appendix J Peer Reviewed Journal Article Requirement.docx	Instruction
CMS-10621 Data Template for Candidate Measures Appendix G JIRA MUC_Template_Blank_2018_to_508.docx	Form and Instruction

IC Title:

414.1330 (Quality 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 414.1330

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
Form and Instruction	CMS-10621	Data Template for Candidate Measures	Appendix G JIRA MUC_Template_Blank_2018_to_508.docx		Yes	Yes	Fillable Fileable
Instruction			Appendix J Peer Reviewed Journal Article Requirement.docx		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 140

Number of Respondents for Small Entity: 140

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	140	100	40
Annual IC Time Burden (Hours)	630	610	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.