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Federal forms, ICRs, and supporting documents

Information Collection

Quality Payment Program Site Intercept Survey (CMS-10804)

IC 267550 under ICR 202405-0938-010 · OMB 0938-1397.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Quality Payment Program Site Intercept Survey (CMS-10804)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10804 QPP Site Intercept Survey CMS-10804 QPP Site Intercept Survey RFA - 508 Compliant.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,200 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,200 0 1,200 0 0 0
Annual IC Time Burden (Hours) 100 0 100 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement CMS-10804 QPP Site Intercept Survey RFA - 508 Compliant.docx 05/09/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.