Information Collection

? 495.24(d)-Objectives/Measures (EPs)

IC 216075 under ICR 202010-0938-002 · OMB 0938-1278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1278 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
UserGuide_QNetHospitalRegistrationAttestation.pdf	Instruction
CMS-10552 Online Attestation Forms Promoting Interoperability Online Attestation Forms_Screenshots.docx	Form and Instruction

IC Title:

§ 495.24(d)-Objectives/Measures (EPs)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 495.24

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			UserGuide_QNetHospitalRegistrationAttestation.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10552	Online Attestation Forms	Promoting Interoperability Online Attestation Forms_Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

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 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,000	-50,000	80,000
Annual IC Time Burden (Hours)	222,900	-371,500	594,400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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