Information Collection Request

Registration, Attestation, Dispute Resolution and Correction, Assumptions Document and Data Retention Requirements for Open Payments (CMS-10495)

ICR 202407-0938-016 · OMB 0938-1237 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10495 Applicable GPO (Data Collection and Submission) Form and Instruction Unchanged Repair queued
Form CMS-10495 GPO Dispute and Resolution Correction Form and Instruction Modified Repair queued
Form CMS-10495 Dispute Resolution and Correction (AM) Form and Instruction Modified Repair queued
Form CMS-10495 Applicable GPO (Assumptions Document) Form and Instruction Unchanged Missing upstream
Form CMS-10495 Applicable GPO (Attestation) Form and Instruction Unchanged Repair queued
Form CMS-10495 Applicable GPO (Registration) Form and Instruction Unchanged Repair queued
Form CMS-10495 AM (Data Collection and Submission) Form and Instruction Unchanged Missing upstream
Form CMS-10495 Dispute and Resolution Correction (Teaching Hospitals) Form and Instruction Modified Missing upstream
Form CMS-10495 Dispute Resolution and Correction (Physicians) Form and Instruction Modified Repair queued
Form CMS-10495 AM (Assumptions Document) Form and Instruction Unchanged Repair queued
Form CMS-10495 AM (Attestation) Form and Instruction Modified Repair queued
Form CMS-10495 Teaching Hospitals (Registration) Form and Instruction Modified Repair queued
Form CMS-10495 Physicians (Registration) Form and Instruction Modified Repair queued
Form CMS-10495 AM (Registration) Form and Instruction Modified Missing upstream
5 - CMS-10495 (0938-1237).SCREENSHOTS - OPS_PRA_REPORTING_ENTITY_REGISTRATION_AND_NOMINATION.docx Supplementary Document Uploaded 2024-07-25 Repair queued
4 - CMS-10495 (0938-1237). SCREENSHOTS - OPS_PRA_REPORTING_ENTITY_REVIEW_AND_DISPUTE_AND_MESSAGES_AND_COMPLIANCE.docx Supplementary Document Uploaded 2024-07-25 Missing upstream
2 & 3- CMS-10495 (0938-1237). SCREENSHOTS - OPS_PRA_COVERED_RECIPIENT_MESSAGES_REGISTRATION_AND_NOMINATION.docx Supplementary Document Uploaded 2024-07-25 Available
1 - CMS-10495 (0938-1237) SCREENSHOTS - OPS_PRA_COVERED_RECIPIENT_REVIEW_AND_DISPUTE.docx Supplementary Document Uploaded 2024-07-25 Repair queued
CMS-10495. Justification of non-sub change (7-22-24).docx Justification for No Material/Nonsubstantive Change Uploaded 2024-07-22 Repair queued
CMS-10495 - Supporting Statement A .docx Supporting Statement A Uploaded 2023-04-13 Missing upstream
Response to Public Comments - Supporting Statement A 3.2.22.docx Supplementary Document Uploaded 2022-05-04 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
238592 Applicable GPO (Data Collection and Submission) Form and Instruction Unchanged
238591 GPO Dispute and Resolution Correction Form and Instruction Modified
238590 Dispute Resolution and Correction (AM) Form and Instruction Modified
238589 Applicable GPO (Assumptions Document) Form and Instruction Unchanged
238588 Applicable GPO (Attestation) Form and Instruction Unchanged
238587 Applicable GPO (Record Retention) Instruction Unchanged
238586 Applicable GPO (Registration) Form and Instruction Unchanged
230225 AM (Data Collection and Submission) Form and Instruction Unchanged
212217 Dispute and Resolution Correction (Teaching Hospitals) Form and Instruction Modified
212216 Dispute Resolution and Correction (Physicians) Form and Instruction Modified
211456 AM (Assumptions Document) Form and Instruction Unchanged
211455 AM (Attestation) Form and Instruction Modified
211454 AM (Record Retention) Instruction Unchanged
209365 Teaching Hospitals (Registration) Form and Instruction Modified
209364 Physicians (Registration) Form and Instruction Modified
209363 AM (Registration) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
07/31/2026 07/31/2026
78,234 78,234
1,946,034 1,946,034
0 0





table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 78,234 78,234 0 0 0 0
Annual Time Burden (Hours) 1,946,034 1,946,034 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No