HEDIS Information Collection Request

HEDIS Data Collection for Medicare Advantage (CMS-10219)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1028 can be found here:

Documents and Forms

Document Name Document Type
Attachment HEDIS Measures and Descriptions.pdf Other-HEDIS® 2020 Measures and Descr
2020 Reporting Requirements Memo Sept 9.pdf Memo - Updated Requirements for Reporting of 2020 Measures IC Document

Information Collection (IC) Details

IC Title:	HEDIS Information Collection Request	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.152

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HEDIS® 2020 Measures and Descriptions for Medicare			Attachment HEDIS Measures and Descriptions.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Health Plan Management System (HPMS)”	FR Citation: 83 FR 6591

Number of Respondents: 677	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	677	162	515
Annual IC Time Burden (Hours)	216,640	51,840	164,800
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Memo - Updated Requirements for Reporting of 2020 Measures	2020 Reporting Requirements Memo Sept 9.pdf	06/25/2020

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