Information Collection

Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Database

IC 211726 under ICR 201405-0915-003 · OMB 0915-0387.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0387 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Database Form
1 Small Health Care Provider Quality Improvement Program P Quality Program PIMS Measures.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Database	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Database	Quality Program PIMS Measures.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 30

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 Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	480	480
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.