Information Collection

Disallowing Record Deletion Without Reason: AM and Applicable GPO Data Collection and Submission

IC 248591 under ICR 202107-0938-014 · OMB 0938-1237.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1237 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10495 Disallowing Record Deletion Without Reason: AM and Applicable GPO Data Collection and Submission	Form and Instruction
CMS-10495 User Guide for Reporting Entities Open Payments User Guide_for_Reporting_Entities - 508 Compliant cf 1-31.pdf	Form and Instruction
CMS-10495 User Guide for Reporting Entities Open Payments User Guide_for_Reporting_Entities - 508 Compliant cf 1-31.pdf	Form and Instruction

IC Title:

Disallowing Record Deletion Without Reason: AM and Applicable GPO Data Collection and Submission

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

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-10495	User Guide for Reporting Entities	Open Payments User Guide_for_Reporting_Entities - 508 Compliant cf 1-31.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 40

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	80	80
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.