Information Collection

2020 Tracking the adoption of alternative payment models (CMS-10620)

IC 240101 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⚠️ Notice: This information collection may be referencing outdated material.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 2020 Tracking the adoption of alternative payment models (CMS-10620)	Form and Instruction
CMS-10620 Informational Questions 5. LAN_2019 Informational Questions_Final copy.docx	Form and Instruction
CMS-10620 National_Data_Collection_Metrics LAN_2020_APM_National_Data_Collection_Metrics0220.xlsx	Form and Instruction
CMS-10620 Online Survey LAN_2020_APM_Online Survey_0220.pdf	Form and Instruction
1. 2020 National APM Metric Overview - 2.18.2020.docx 2020 National APM Metric Overview	IC Document
3. LAN_2020_Frequently Asked Questions_0220.docx 2020_Frequently Asked Questions	IC Document
4. 2020 Burden Estimate_v1.docx Burden Estimate	IC Document
2. CMS-10620 GenIC - Supporting Statement - 2.18.2020.docx Supporting Statement	IC Document

IC Title:

2020 Tracking the adoption of alternative payment models (CMS-10620)

Agency IC Tracking Number:

CMMI

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10620	Informational Questions	5. LAN_2019 Informational Questions_Final copy.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10620	National_Data_Collection_Metrics	LAN_2020_APM_National_Data_Collection_Metrics0220.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10620	Online Survey	LAN_2020_APM_Online Survey_0220.pdf	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
2020 National APM Metric Overview	1. 2020 National APM Metric Overview - 2.18.2020.docx	02/25/2020
2020_Frequently Asked Questions	3. LAN_2020_Frequently Asked Questions_0220.docx	02/25/2020
Burden Estimate	4. 2020 Burden Estimate_v1.docx	02/25/2020
Supporting Statement	2. CMS-10620 GenIC - Supporting Statement - 2.18.2020.docx	02/25/2020

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