Information Collection

Consumer Research on Public Reporting of Hospital Quality Measures (CMS-10360) - Initial Screening Round 3 Cognitive Interviews

IC 196978 under ICR 201103-0938-005 · OMB 0938-1143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1143 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B2_Cognitive Testing Interview Guide HAC_HAI_ED_1_27_2011.docx	Instruction
HAI_HAC_MockUps_DRAFT_1_28_REV.docx HAI_HAC_MockUps_DRAFT_1_28_REV	IC Document

IC Title:

Consumer Research on Public Reporting of Hospital Quality Measures (CMS-10360) - Initial Screening Round 3 Cognitive Interviews

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment B2_Cognitive Testing Interview Guide HAC_HAI_ED_1_27_2011.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	60	0	0	0	0	0
Annual IC Time Burden (Hours)	30	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HAI_HAC_MockUps_DRAFT_1_28_REV	HAI_HAC_MockUps_DRAFT_1_28_REV.docx	02/18/2011

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