Information Collection

(PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 19)

IC 229074 under ICR 201911-0938-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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 (PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 19) Form and Instruction
CMS-10621 Promoting Interoperability Performance Category: Call fo Appendix P 2020 PI Call for Measures Submission Form.docx Form and Instruction
Appendix Q 2020 PI Call for Measures Submission Form Crosswalk.docx Crosswalk IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	(PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 19)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 414.1375

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	Promoting Interoperability Performance Category: Call for Measures Submission Form	Appendix P 2020 PI Call for Measures Submission Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Quality Payment Program (QPP), System No. 09â70â 0539	FR Citation: 83 FR 6587

Number of Respondents: 10	Number of Respondents for Small Entity: 10

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	Previously Approved
Annual Number of Responses for this IC	10	-37	47
Annual IC Time Burden (Hours)	5	-19	24
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	Appendix Q 2020 PI Call for Measures Submission Form Crosswalk.docx	11/22/2019

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