Information Collection

Appeals of Quality Bonus Payment Determinations

IC 195883 under ICR 202012-0938-011 · OMB 0938-1129.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1129 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10346 Appeals of Quality Bonus Payment Determinations	Form and Instruction
CMS-10346 Request for Reconsideration Request_For_Reconsideration_Form_2020.pdf	Form and Instruction
CMS-10346 Request for Reconsideration Request_For_Reconsideration_Form_2020.pdf	Form and Instruction

IC Title:

Appeals of Quality Bonus Payment Determinations

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 422.260

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
Form and Instruction	CMS-10346	Request for Reconsideration	Request_For_Reconsideration_Form_2020.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	160	160
Annual IC Cost Burden (Dollars)	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.