OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Quarterly VBP-MBP Data (CMS-367e)

IC 252230 under ICR 202606-0938-019 · OMB 0938-0578.

Documents and Forms
Document Name
Document Type
Form
Instruction
Form
Information Collection (IC) Details

View Information Collection (IC)

Quarterly VBP-MBP Data (CMS-367e)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-367e Quarterly VBP-MBP Data CMS Form-367e MDP Online Data Entry Mockup_09.2021.pdf Yes Yes Fillable Fileable
Instruction CMS Form-367e_Quarterly VBP-MBP_09.2021_Final.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

50 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 200 0 0 0 0 200
Annual IC Time Burden (Hours) 200 0 0 0 0 200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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