Information Collection

2021 > (PI Performance Category) Data Submission (see SS-A Table 18)

IC 221784 under ICR 202101-0938-003 · OMB 0938-1314.

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Information Collection (IC) Details

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IC Title:	2021 > (PI Performance Category) Data Submission (see SS-A Table 18)	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

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: 53,636	Number of Respondents for Small Entity: 53,636

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	53,636	-20,645	74,281
Annual IC Time Burden (Hours)	143,208	-54,875	198,083
Annual IC Cost Burden (Dollars)	0	0	0

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