Information Collection

Tracking the adoption of alternative payment models (CMS-10620)

IC 255474 under ICR 202202-0938-003 · OMB 0938-1297.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10620 Tracking the adoption of alternative payment models (CMS-10620)	Form and Instruction
CMS-10620 Informational Questions 5. 2022 LAN Informational Questions.docx	Form and Instruction
CMS-10620 National Data Collection Metrics 6. 2022 APM National Data Collection Metrics_04192022.xlsx	Form and Instruction
CMS-10620 LAN Informational Questions 5. 2022 LAN Informational Questions.docx	Form and Instruction
2. CMS-10620 GenIC - Supporting Statement - 4.1.2022.docx Supporting Statement	IC Document
1. 2022 National APM Metric Overview_4.1.2022.docx National APM Metric Overview	IC Document
3. 2022 -APM-Measurement-FAQ_05.09.2022.docx APM-Measurement-FAQ	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10620	Informational Questions	5. 2022 LAN Informational Questions.docx	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10620	National Data Collection Metrics	6. 2022 APM National Data Collection Metrics_04192022.xlsx	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10620	LAN Informational Questions	5. 2022 LAN Informational Questions.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	1,350	1,350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	2. CMS-10620 GenIC - Supporting Statement - 4.1.2022.docx	08/22/2022
National APM Metric Overview	1. 2022 National APM Metric Overview_4.1.2022.docx	08/22/2022
APM-Measurement-FAQ	3. 2022 -APM-Measurement-FAQ_05.09.2022.docx	08/22/2022

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