Inpatient Psychiatric Facility Quality Reporting Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1171 can be found here:

Documents and Forms

Document Name Document Type
Form 10432 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction
10432 Participation, Decline to Participate, Withdrawal and Wa Appendices_forms.5-1-2012.docx Form and Instruction
10432 Web-based Measure Online Data Entry Tool Content Data collection.docx Form
Notification Letter.docx Notification letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Inpatient Psychiatric Facility Quality Reporting Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10432	Participation, Decline to Participate, Withdrawal and Waiver Forms	Appendices_forms.5-1-2012.docx		Yes	Yes	Fillable Printable
Form	10432	Web-based Measure Online Data Entry Tool Content	Data collection.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,741	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 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	471,811	471,811
Annual IC Time Burden (Hours)	1,415,433	1,415,433
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Notification letter	Notification Letter.docx	05/01/2012

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