Information Collection

National Voluntary Hospital Reporting Initiative--Hospital Quality Measures

IC 8762 under ICR 200610-0938-008 · OMB 0938-0918.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10109 National Voluntary Hospital Reporting Initiative--Hospital Quality Measures	Form and Instruction
CMS-10109 CMS-10109.final praoryx CMS-10109.final praoryx.doc	Form and Instruction
CMS-10109 CMS-10109.final praqnet CMS-10109.final praqnet.doc	Form and Instruction
CMS-10109 CMS-10109.CART Summary CMS-10109.CART Summary.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10109	CMS-10109.final praoryx	CMS-10109.final praoryx.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10109	CMS-10109.final praqnet	CMS-10109.final praqnet.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10109	CMS-10109.CART Summary	CMS-10109.CART Summary.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	12,400	-3,600	16,000
Annual IC Time Burden (Hours)	337,776	99,776	238,000
Annual IC Cost Burden (Dollars)	0	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.