Information Collection

Tracking the adoption of alternative payment models (CMS-10620)

IC 235746 under ICR 201902-0938-001 · OMB 0938-1297.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1297 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10620 Tracking the adoption of alternative payment models (CMS-10620)	Form and Instruction
CMS-10620 National_Data_Collection_Metrics 6. LAN_2019_National_Data_Collection_Metrics.xlsx	Form and Instruction
CMS-10620 Informational Questions 5. LAN_2019 Informational Questions_Final.docx	Form and Instruction
3. LAN_2019_Frequently Asked Questions.docx Frequently Asked Questions	IC Document
2. CMS-10620 GenIC - Supporting Statement - 04052019.docx Supporting Statment	IC Document
4. 2019 Burden Estimate_04052019.docx Burden Estimate	IC Document
1. 2019 National APM Metric Overview - 04052019.docx APM Metric Overview	IC Document

IC Title:

Tracking the adoption of alternative payment models (CMS-10620)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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-10620	National_Data_Collection_Metrics	6. LAN_2019_National_Data_Collection_Metrics.xlsx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10620	Informational Questions	5. LAN_2019 Informational Questions_Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Frequently Asked Questions	3. LAN_2019_Frequently Asked Questions.docx	04/17/2019
Supporting Statment	2. CMS-10620 GenIC - Supporting Statement - 04052019.docx	04/17/2019
Burden Estimate	4. 2019 Burden Estimate_04052019.docx	04/17/2019
APM Metric Overview	1. 2019 National APM Metric Overview - 04052019.docx	04/17/2019

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