Information Collection Request
Registration, Attestation, Dispute Resolution and Correction, Assumptions Document and Data Retention Requirements for Open Payments (CMS-10495)
ICR 202304-0938-008 · OMB 0938-1237 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1237 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10495 Applicable GPO (Data Collection and Submission) |
Form and Instruction | Modified | Repair queued |
| Form CMS-10495 GPO Dispute and Resolution Correction |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10495 Dispute Resolution and Correction (AM) |
Form and Instruction | Modified | Repair queued |
| Form CMS-10495 Applicable GPO (Assumptions Document) |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10495 Applicable GPO (Attestation) |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10495 Applicable GPO (Registration) |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10495 AM (Data Collection and Submission) |
Form and Instruction | Modified | Repair queued |
| Form CMS-10495 Dispute and Resolution Correction (Teaching Hospitals) |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10495 Dispute Resolution and Correction (Physicians) |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10495 AM (Assumptions Document) |
Form and Instruction | Modified | Repair queued |
| Form CMS-10495 AM (Attestation) |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10495 Teaching Hospitals (Registration) |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10495 Physicians (Registration) |
Form and Instruction | Unchanged | Repair queued |
| Form CMS-10495 AM (Registration) |
Form and Instruction | Modified | Repair queued |
 CMS-10495 - Supporting Statement A .docx |
Supporting Statement A | Uploaded 2023-04-13 | Repair queued |
| Response to Public Comments - Supporting Statement A 3.2.22.docx |
Supplementary Document | Uploaded 2022-05-04 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 238592 |  Applicable GPO (Data Collection and Submission) |
Form and Instruction | Modified | |
| 238591 | GPO Dispute and Resolution Correction |
Form and Instruction | Unchanged | |
| 238590 | Dispute Resolution and Correction (AM) |
Form and Instruction | Modified | |
| 238589 | Applicable GPO (Assumptions Document) |
Form and Instruction | Unchanged | |
| 238588 | Applicable GPO (Attestation) |
Form and Instruction | Unchanged | |
| 238587 | Applicable GPO (Record Retention) |
Instruction | Unchanged | |
| 238586 | Applicable GPO (Registration) |
Form and Instruction | Unchanged | |
| 230225 | AM (Data Collection and Submission) |
Form and Instruction | Modified | |
| 212217 | Dispute and Resolution Correction (Teaching Hospitals) |
Form and Instruction | Unchanged | |
| 212216 | Dispute Resolution and Correction (Physicians) |
Form and Instruction | Unchanged | |
| 211456 | AM (Assumptions Document) |
Form and Instruction | Modified | |
| 211455 | AM (Attestation) |
Form and Instruction | Unchanged | |
| 211454 | AM (Record Retention) |
Instruction | Modified | |
| 209365 | Teaching Hospitals (Registration) |
Form and Instruction | Unchanged | |
| 209364 | Physicians (Registration) |
Form and Instruction | Unchanged | |
| 209363 | AM (Registration) |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1237 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202112-0938-008 |
| Agency Tracking No | CPI |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |