Information Collection Request

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

ICR 202511-0938-012 · OMB 0938-1237 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-10495 General-Research-Ownership Submission Data Elements Screen Shots Form and Instruction Modified Repair queued
Form CMS-10495 Open Payments User Guide Form and Instruction Modified Available
Form CMS-10495 Review and Dispute Email Notifications Form and Instruction Modified Available
Form CMS-10495 Review and Dispute Screen Shots Form and Instruction Modified Repair queued
Form CMS-10495 Review and Dispute Email Notifications Form and Instruction Modified Available
Form CMS-10495 Review and Dispute Screen Shots Form and Instruction Modified Repair queued
Form CMS-10495 Assumptions Form and Instruction Modified Repair queued
Form CMS-10495 Attestation Form and Instruction Modified Repair queued
Form CMS-10495 Registration Form and Instruction Modified Repair queued
Form CMS-10495 General-Research-Ownership Submission Data Elements and Screen Shots Form and Instruction Unchanged Available
Form CMS-10495 Open Payments User Guide Form and Instruction Unchanged Repair queued
Form CMS-10495 Review and Dispute Email Notifications Form and Instruction Modified Available
Form CMS-10495 Review and Dispute Screen Shots Form and Instruction Modified Available
Form CMS-10495 Review and Dispute Email Notifications Form and Instruction Modified Repair queued
Form CMS-10495 Review and Dispute Screen Shots Form and Instruction Modified Repair queued
Form CMS-10495 Assumptions Form and Instruction Modified Available
Form CMS-10495 Attestation Form and Instruction Modified Repair queued
Form CMS-10495 Registration Form and Instruction Modified Available
Form CMS-10495 Registration Form and Instruction Modified Available
Form CMS-10495 Registration Form and Instruction Modified Available
CMS-10495 Supporting Statement.docx Supporting Statement A Uploaded 2025-11-20 Available
IC Document Collections
IC IDCollectionTypeStatusForm
238592 Applicable GPO (Data Collection and Submission) Form and Instruction ModifiedGeneral-Research-Ownership Submission Data Elements Screen Shots
238592 Applicable GPO (Data Collection and Submission) Form and Instruction ModifiedOpen Payments User Guide
238591 GPO Dispute and Resolution Correction Form and Instruction ModifiedReview and Dispute Email Notifications
238591 GPO Dispute and Resolution Correction Form and Instruction ModifiedReview and Dispute Screen Shots
238590 Dispute Resolution and Correction (AM) Form and Instruction ModifiedReview and Dispute Email Notifications
238590 Dispute Resolution and Correction (AM) Form and Instruction ModifiedReview and Dispute Screen Shots
238589 Applicable GPO (Assumptions Document) Form and Instruction ModifiedAssumptions
238588 Applicable GPO (Attestation) Form and Instruction ModifiedAttestation
238587 Applicable GPO (Record Retention) Instruction Modified
238586 Applicable GPO (Registration) Form and Instruction ModifiedRegistration
230225 AM (Data Collection and Submission) Form and Instruction UnchangedGeneral-Research-Ownership Submission Data Elements and Screen Shots
230225 AM (Data Collection and Submission) Form and Instruction UnchangedOpen Payments User Guide
212217 Dispute and Resolution Correction (Teaching Hospitals) Form and Instruction ModifiedReview and Dispute Email Notifications
212217 Dispute and Resolution Correction (Teaching Hospitals) Form and Instruction ModifiedReview and Dispute Screen Shots
212216 Dispute Resolution and Correction (Physicians) Form and Instruction ModifiedReview and Dispute Email Notifications
212216 Dispute Resolution and Correction (Physicians) Form and Instruction ModifiedReview and Dispute Screen Shots
211456 AM (Assumptions Document) Form and Instruction ModifiedAssumptions
211455 AM (Attestation) Form and Instruction ModifiedAttestation
211454 AM (Record Retention) Instruction Modified
209365 Teaching Hospitals (Registration) Form and Instruction ModifiedRegistration
209364 Physicians (Registration) Form and Instruction ModifiedRegistration
209363 AM (Registration) Form and Instruction ModifiedRegistration
ICR Details
0938-1237 202511-0938-012
Received in OIRA 202407-0938-016
HHS/CMS CPI
Registration, Attestation, Dispute Resolution and Correction, Assumptions Document and Data Retention Requirements for Open Payments (CMS-10495)
Extension without change of a currently approved collection   No
Regular 12/08/2025
  Requested Previously Approved
36 Months From Approved 07/31/2026
51,480 78,234
1,873,839 1,946,034
0 0

Section 6002 of the Affordable Care Act added section 1128G to the Social Security Act (Act), which requires applicable manufacturers and applicable group purchasing organizations (GPOs) of covered drugs, devices, biologicals, or medical supplies to report annually to CMS certain payments or other transfers of value to physicians and teaching hospitals, as well as, certain information regarding the ownership or investment interests held by physicians or the immediate family members of physicians in such entities. Specifically, applicable manufacturers of covered drugs, devices, biologicals, and medical supplies are required to submit on an annual basis the information required in section 1128G(a)(1) of the Act about certain payments or other transfers of value made to physicians and teaching hospitals (collectively called covered recipients) during the course of the preceding calendar year. Similarly, section 1128G(a)(2) of the Act requires applicable manufacturers and applicable GPOs to disclose any ownership or investment interests in such entities held by physicians or their immediate family members, as well as information on any payments or other transfers of value provided to such physician owners or investors. Applicable manufacturers must report the required payment and other transfer of value information annually to CMS in an electronic format. The statute also provides that applicable manufacturers and applicable GPOs must report annually to CMS the required information about physician ownership and investment interests, including information on any payments or other transfers of value provided to physician owners or investors, in an electronic format by the same date. This information collection request includes the Registration, Attestation, Assumptions Document and Data Retention Requirements this program.

PL: Pub.L. 111 - 148 6002 Name of Law: Affordable Care Act
  
PL: Pub.L. 111 - 148 6002 Name of Law: Affordable Care Act

Not associated with rulemaking

  90 FR 40073 08/18/2025
90 FR 52406 11/20/2025
No

  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 51,480 78,234 0 -26,754 0 0
Annual Time Burden (Hours) 1,873,839 1,946,034 0 -72,195 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Changes to burden in this package are based on several adjustments to the burden calculation methodologies that had been previously used, and which now encompass the following changes: (1) the number of entities, records, and disputes were updated from Program Year 2019 to Program Year 2023; (2) the total number of estimated hours for the mean hourly wage estimates were updated to BLS May 2023 National Occupational Employment and Wage Estimates. No burden-impacting updates to the system or program have been implemented since the previous iteration of this package.

$18,169,775
No
    No
    No
Yes
No
No
No
Malcolm Wilson 667 414-0087 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/08/2025