Inpatient Psychiatric Facility Quality Reporting Program

Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1171 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10432 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction
CMS-10432 IPF Screen Shots IPF Screen Shots.docx Form and Instruction
CMS-10432 SUB-1 Measure SUB-1 collection form.docx Form
CMS-10432 TOB & IMM Measures TOB & IMM collection form.docx Form
CMS-10432 EHR & Patient Exp of Care Measures EHR & Pt Experience 2016.docx Form
IPFQR PRA crosswalk [rev 8-15-2014 by OSORA PRA].docx Crosswalk IC Document

Information Collection (IC) Details

IC Title:	Inpatient Psychiatric Facility Quality Reporting Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10432	IPF Screen Shots	IPF Screen Shots.docx	Yes	Yes	Fillable Printable
Form	CMS-10432	SUB-1 Measure	SUB-1 collection form.docx	Yes	Yes	Fillable Printable
Form	CMS-10432	TOB & IMM Measures	TOB & IMM collection form.docx	Yes	Yes	Fillable Printable
Form	CMS-10432	EHR & Patient Exp of Care Measures	EHR & Pt Experience 2016.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,626	Number of Respondents for Small Entity: 0

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	904,056	307,856	0	596,200
Annual IC Time Burden (Hours)	1,939,005	-445	-339,750	2,279,200
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	IPFQR PRA crosswalk [rev 8-15-2014 by OSORA PRA].docx	08/15/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.