Information Collection Request

Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

ICR 201405-0938-003 · OMB 0938-1171 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10432 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction Modified Available
CMS-10432 - Supporting Statement A [rev 5-22-2014 by OSORA PRA].docx Supporting Statement A Uploaded 2014-05-23 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
202349 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2017 36 Months From Approved 02/28/2017
596,200 0 596,200
2,279,200 0 2,279,200
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
Inpatient Psychiatric Facility Quality Reporting Program CMS-10432, CMS-10432, CMS-10432, CMS-10432 IPFQR (Screen Shots) ,   EHR & Patient Experience (data collection form) ,   TOB & IMM (data collection form) ,   SUB-1 (data collection form)



Reginfo record details
  No