Hospice QRP Program Evaluation

Hospice Quality Reporting Program: Program Evaluation

OMB: 0938-1243

IC ID: 211030

Documents and Forms
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Hospice QRP Program Evaluation
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10504 Structured Interview Questions - Hospice HospiceMonitoringQuestions.11.14.13..pdf Yes Yes Fillable Fileable

Health Health Care Services

Long Term Care Hospitals Quality Reporting Program (LTCH QRP)  78 FR 8535

30 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 30 0 30 0 0 0
Annual IC Time Burden (Hours) 71 0 71 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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