Information Collection

QPP Submissions Intercept Survey (CMS-10838)

IC 272504 under ICR 202405-0938-010 · OMB 0938-1397.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10838 Survey Instrument - Submissions Intercept QPP Submissions Intercept Survey (CMS-10838)	Form and Instruction
CMS-10838 Survey Instrument - Submissions Intercept CMS-10838 PY24 Survey Instrument_Submissions Intercept clean.docx	Form and Instruction
CMS-10838 PY24 Survey Instrument_ Submissions Intercept track changes.docx Crosswalk Instrument	IC Document
CMS-10838.GenIC - Supporting Statement (11-22-24).docx CMS-10838.GenIC - Supporting Statement (11-22-24)	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10838				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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk Instrument		11/20/2024
CMS-10838.GenIC - Supporting Statement (11-22-24)		11/22/2024

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

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