Quality Measures and Procedures for Hospital Reporting of Quality Data

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)

OMB: 0938-1022

IC ID: 204350

Information Collection (IC) Details

View Information Collection (IC)

Quality Measures and Procedures for Hospital Reporting of Quality Data
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10210 Hospital Data Validation HospValidAppeal_Paper Part1.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Reconsideration Request Online ReconsiderationRequest Online Form.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Reconsideration Request Paper ReconsiderationRequestPaper Form.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Extroadinary Circumstance Online Extraordinary Circumstance Online Form.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Extroadinary Circumstance Paper ExtraordinaryCircumstance_Paper Form.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Reconsideration Request Part 2 Recon Request_Part 2.doc Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Decline to Participate Decline_Participate_Form.doc Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Data Accuracy and Completeness Decline_Participate_Form.doc Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Notice of Participation Notice of Participation.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 HAI Exception Online HAI Exception Online Form.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10210 HAI Exception Paper HAI Exception_Paper Form.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

4,400 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved 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 17,600 0 17,600 0 0 0
Annual IC Time Burden (Hours) 6,750,000 0 6,750,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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