QECP Application, Reapplication, DUA and ARW

Application To Be a Qualified Entity to Receive Medicare Data for Performance Measurement / Reapplication / Annual Report Worksheet (CMS-10394)

OMB: 0938-1144

IC ID: 198017

Documents and Forms

Document Name Document Type
Form CMS-10394 QECP Application, Reapplication, DUA and ARW Form and Instruction
CMS-10394 QECP Paper-Based Reapplication Form QECP-TEM-PprBsReappFrm.pdf Form and Instruction
CMS-10394 Phase 1 Application Readiness Checklist QECP-CHK-Phs1AppRdy.pdf Form and Instruction
CMS-10394 Phase 2 Application Readiness Checklist QECP-CHK-Phs2AppRdy.pdf Form and Instruction
QECP-SUPP-DtaScrtyAdt.pdf Instruction
CMS-10394 Phase 3 Application Readiness Checklist QECP-CHK-Phs3AppRdy.pdf Form and Instruction
CMS-10394 Qualified Entity Certification Program Data Security Review (QECP DSR) QECP-DSR.pdf Form and Instruction
CMS-10394 Letter of Commitment Template QECP-TEM-LtrCmmtmnt.pdf Form and Instruction
CMS-10394 Extension Request Letter QECPProgramGuide.pdf Form and Instruction
QECP-SUPP-MIWrqrmnts.pdf Instruction
QECP-SUPP-ARWRqmnts.pdf Instruction
CMS-10394 Public Report Submission Form QECP-FORM-PbRptSubmsn.pdf Form and Instruction
CMS-10394 QECP Data Source Attestation Workbook QECP-WKB-SmpDtSceAttstn.xlsx Form and Instruction