2020 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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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:

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 %

	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
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.