Information Collection Request

Hospital Reporting Initiative--Hospital Quality Measures

ICR 201208-0938-001 · OMB 0938-1022 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 10210 Inpatient Hospital Compare Form and Instruction New Available
Form 10210 Validation Review for Reconsideration Request Form and Instruction New Available
Form 10210 Reconsideration Request Form and Instruction New Available
Form 10210 Healthcare Associated Infection Exception Form Form New Available
Form 10210 Extraordinary Circumstances/Waiver Request Form Form and Instruction New Available
Form 10210 Data Validation Appeal Form Form and Instruction New Available
Form 10210 Notice of Participation Form and Instruction New Available
Form 10210 Data Accuracy Form Form New Available
Form CMS-10210 Notice of Participation Form and Instruction Removed Available
Form CMS-10210 HIPAA Compliance Form Removed Available
Form CMS-10210 Qnet Form Removed Available
Form CMS-10210 Oryx Form Removed Available
Form CMS-10210 Cart Summary Form Removed Available
Form CMS-10210 Notice of Participation Form and Instruction Removed Available
Form CMS-10210 HIPAA Compliance Form Removed Available
Form CMS-10210 Qnet Form Removed Available
Form CMS-10210 Oryx Form Removed Available
Form CMS-10210 Cart Summary Form Removed Available
CMS 10210 Supporting Statement A.docx Supporting Statement A Uploaded 2012-05-14 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
203642 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction NewInpatient Hospital Compare
203642 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction NewValidation Review for Reconsideration Request
203642 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction NewReconsideration Request
203642 Quality Measures and Procedures for Hospital Reporting of Quality Data Form NewHealthcare Associated Infection Exception Form
203642 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction NewExtraordinary Circumstances/Waiver Request Form
203642 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction NewData Validation Appeal Form
203642 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction NewNotice of Participation
203642 Quality Measures and Procedures for Hospital Reporting of Quality Data Form NewData Accuracy Form
178678 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form and Instruction RemovedNotice of Participation
178678 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form RemovedHIPAA Compliance
178678 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form RemovedQnet
178678 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form RemovedOryx
178678 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form RemovedCart Summary
178677 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form and Instruction RemovedNotice of Participation
178677 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form RemovedHIPAA Compliance
178677 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form RemovedQnet
178677 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form RemovedOryx
178677 Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) Form RemovedCart Summary

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
0 0 0
0 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210 ,   ,   ,   ,  
Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210 ,   ,   ,   ,  
Quality Measures and Procedures for Hospital Reporting of Quality Data 10210, 10210, 10210, 10210, 10210, 10210, 10210, 10210 ,   ,   ,   ,   ,   ,   ,  



Reginfo record details
  No