Hospital Leadership Quality Assessment Tool (HLQAT) - Medical Director

Hospital Leadership Quality Assessment Tool (HLQAT)

OMB: 0938-1060

IC ID: 187927

Documents and Forms
Information Collection (IC) Details

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Hospital Leadership Quality Assessment Tool (HLQAT) - Medical Director
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10272 HLQAT Instrument CMS-10272.Instrument.doc Yes Yes Fillable Fileable

Health Health Care Services

 

1,500 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved 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 3,000 0 3,000 0 0 0
Annual IC Time Burden (Hours) 2,610 0 2,610 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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