Information Collection

(Quality Performance Category) Call for Quality Measures (see SS-A Table 15)

IC 229086 under ICR 201812-0938-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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 (Quality Performance Category) Call for Quality Measures (see SS-A Table 15) Form and Instruction
Appendix J Peer Reviewed Journal Article Requirement (version 2).docx Instruction
CMS-10621 Data Template for Candidate Measures Appendix G JIRA MUC_Template_Blank_2018_to_508 (version 2).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	(Quality Performance Category) Call for Quality Measures (see SS-A Table 15)	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:

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 (version 2).docx		Yes	Yes	Fillable Fileable
Instruction			Appendix J Peer Reviewed Journal Article Requirement (version 2).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 %

	Approved	Change Due to Adjustment in Agency Estimate	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

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.