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

Generic Clearance for the Heath Care Payment Learning and Action Network (CMS-10575)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.