Information Collection Request

Implementation of Medicare and Medicaid Programs; - Promoting Interoperability Programs Stage 3 (CMS-10552)

ICR 202112-0938-013 · OMB 0938-1278 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10552 Attestation screen shots Form and Instruction Modified Repair queued
Form CMS-10552 ?495.24(e) Objectives/Measures (hospitals/CAHs) Form and Instruction Modified Repair queued
Form CMS-10552 Online Attestation Forms Form and Instruction Removed Repair queued
CMS-10552_Supporting_Statement_Part_A_FY 2022 rule _(09-27-2021)_CLEAN.docx Supporting Statement A Uploaded 2021-12-21 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
231472 §495.24(d) Objectives/Measures Medicaid (eligible hospitals/CAHs) Removed
216085 §495.316 – Quarterly Reporting Removed
216082 §495.24(e) Objectives/Measures (hospitals/CAHs) Form and Instruction ModifiedAttestation screen shots
216082 ?495.24(e) Objectives/Measures (hospitals/CAHs) Form and Instruction Modified
216082 §495.24(e) Objectives/Measures (hospitals/CAHs) Instruction Modified
216075 § 495.24(d)-Objectives/Measures (EPs) Form and Instruction RemovedOnline Attestation Forms
216075 § 495.24(d)-Objectives/Measures (EPs) Instruction Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2025 36 Months From Approved 08/31/2022
3,300 0 33,657
21,450 0 249,818
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
§ 495.24(d)-Objectives/Measures (EPs) CMS-10552
§495.24(d) Objectives/Measures Medicaid (eligible hospitals/CAHs)
§495.24(e) Objectives/Measures (hospitals/CAHs) CMS-10552
§495.316 – Quarterly Reporting

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,300 33,657 0 -30,357 0 0
Annual Time Burden (Hours) 21,450 249,818 0 -228,368 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No