PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program

PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CMS-10431 PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program Form and Instruction
CMS-10431 Notice of Participation PCHQR.NOP.Aug_26_2012.rvised.V1.0.docx Form and Instruction
CMS-10431 Data Accuracy and Completeness PCHQR.DACA form.Aug_27_2012.docx Form and Instruction
CMS-10431 HAI Exception HAI Exception_Paper Form Aug_27_2012.docx Form and Instruction
CMS-10431 Decline to Participate PCHQR.DeclineParticipation.Aug_26_2012_.docx Form and Instruction
CMS-10431 Withdrawal Withdrawalform.Aug_26_2012_.docx Form and Instruction

Information Collection (IC) Details

IC Title:	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10431	Notice of Participation	PCHQR.NOP.Aug_26_2012.rvised.V1.0.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Data Accuracy and Completeness	PCHQR.DACA form.Aug_27_2012.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	HAI Exception	HAI Exception_Paper Form Aug_27_2012.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Decline to Participate	PCHQR.DeclineParticipation.Aug_26_2012_.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Withdrawal	Withdrawalform.Aug_26_2012_.docx	Yes	Yes	Fillable Fileable

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 %

	Approved	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

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.