Quality Measures and Procedures for Hospital Reporting of Quality Data

Hospital Reporting Initiative--Hospital Quality 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 Modified
 
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 Reconsideration Reqeust Paper Form Four_Page_ReconsiderationRequest_English.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Reconsideration Request Online Form Four_Page_ReconsiderationRequest_English.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Hospital Value-Based Program Appeal Request Form HVBP Appeal Request Form_03_2013.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Hospital Value Based Review and Correction Request Form HVBP Review and Corrections Request Form_03_2013.pdf No Yes Fillable Fileable
Form and Instruction CMS-10210 Hospital Value-Based Purchasing Program Appeal Request Form VBP Appeal Request Form_03_2013.doc Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Hosptial Value-Based Purchasing Review and Corrections Request Form VBP Review and Corrections Request Form_03_2013.doc Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Proposed FY2016 Validation Template for CDI cditemplatedraft.xlsx No No Fillable Fileable
Form and Instruction CMS-10210 Proposed FY2016 Positive Blood Culture Template FY16_CLABSI_BloodCultureTemplate_proposed.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Proposed FY2016 Positive Urine Culture Template FY16_validation_CAUTI_UrineCultureTemplate_proposed.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Proposed FY2016 Validation Template for MRSA mrsatemplatedraft.xlsx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

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

  Requested 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 0 0 0 17,600
Annual IC Time Burden (Hours) 6,050,000 0 -700,000 0 0 6,750,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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