Information Collection Request

Add-On Payments for New Medical Services and Technologies Paid Under the Inpatient Prospective Payment System (IPPS) (CMS-10638)

ICR 202309-0938-008 · OMB 0938-1347 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10638 New Technology Application Form New Available
Form CMS-10638 Alternative NTAP Pathway Form New Repair queued
Form CMS-10638 New Technology Application Form Modified Available
Form CMS-10638 Traditional NTAP Pathway Form Modified Repair queued
CMS-10638 Supporting Statement Part A 2023_.docx Supporting Statement A Uploaded 2023-09-20 Repair queued
NTAP Crosswalk FY 2025 Program 30d clean.pdf Supplementary Document Uploaded 2023-09-14 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
262237 Alternative NTAP Pathway Form NewNew Technology Application
262237 Alternative NTAP Pathway Form New
227314 Traditional NTAP Pathway Form ModifiedNew Technology Application
227314 Traditional NTAP Pathway Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2026 36 Months From Approved 12/31/2023
62 0 62
1,655 0 1,655
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Alternative NTAP Pathway CMS-10638
Traditional NTAP Pathway CMS-10638

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 62 62 0 0 0 0
Annual Time Burden (Hours) 1,655 1,655 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No