QPP Submissions Intercept Survey (CMS-10838)

Generic Clearance for the Center for Clinical Standards and Quality IT Product and Support Teams (CMS-10706)

Documents and Forms

Document Name Document Type
Form CMS-10838 QPP Submissions Intercept Survey (CMS-10838) Form and Instruction
CMS-10838 Submissions Intercept Survey CMS-10838 Submissions Intercept Survey instrument clean.docx Form and Instruction
CMS-10838 Submissions Intercept Survey CMS-10838 Submissions Intercept Survey instrument clean.docx Form and Instruction
CMS-10838 PY23 Submissions Intercept Survey Supporting Statement.docx Supporting Statement IC Document
CMS-10838 PY23 Submissions Intercept Survey Supporting Statement.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	QPP Submissions Intercept Survey (CMS-10838)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10838	Submissions Intercept Survey	CMS-10838 Submissions Intercept Survey instrument clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	CMS-10838 PY23 Submissions Intercept Survey Supporting Statement.docx	05/09/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.