Information Collection Request
Application To Be a Qualified Entity to Receive Medicare Data for Performance Measurement / Reapplication / Annual Report Worksheet (CMS-10394)
ICR 202404-0938-006 · OMB 0938-1144 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1144 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10394 QECP Application, Reapplication, DUA and ARW |
Form and Instruction | Modified | Repair queued |
 QECP-SUPP-PRAIns-Chngs-V2.docx |
Supplementary Document | Uploaded 2024-04-08 | Repair queued |
| CMS-10394-QECP-SpprtgStmnt.docx |
Supporting Statement A | Uploaded 2024-04-08 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 198017 |  QECP Application, Reapplication, DUA and ARW |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1144 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202203-0938-012 |
| Agency Tracking No | OEDA |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |