Information Collection

PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program

IC 202342 under ICR 201205-0938-004 · OMB 0938-1175.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1175 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10431 PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program	Form and Instruction
10431 Notice of Participation, Decline, Data Accuracy Forms Appendices_Forms.Revised_5-1-2012.docx	Form and Instruction

IC Title:

PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program

Agency IC Tracking Number:

Is this a Common Form? No

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
Form and Instruction	10431	Notice of Participation, Decline, Data Accuracy Forms	Appendices_Forms.Revised_5-1-2012.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	27,273	27,273
Annual IC Time Burden (Hours)	68,182	68,182
Annual IC Cost Burden (Dollars)	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.