Information Collection

ICD–10–PCS Application

IC 248479 under ICR 202406-0938-003 · OMB 0938-1409.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10774 ICD–10–PCS Application	Form and Instruction
CMS-10774 International Classification of Diseases, 10th Revision, ICD-10 Request Preview.pdf	Form and Instruction
CMS-10774 International Classification of Diseases, 10th Revision, ICD-10 Request Preview.pdf	Form and Instruction

IC Title:

ICDâ10âPCS Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 162.1002

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-10774	International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) Request Preview	ICD-10 Request Preview.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

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	Previously Approved
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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