Information Collection

Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)

IC 209855 under ICR 201412-0938-001 · OMB 0938-1109.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1109 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10250 Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)	Form and Instruction
CMS-10250 Request for Reconsideration Part 1 HosOQR_ReconFormPart1_012313.pdf	Form and Instruction
CMS-10250 Request for Reconsideration Part 2 HosOQR_ReconFormPart_2_012313.pdf	Form and Instruction
CMS-10250 Extroadinary Circumstances ExtrordryCrcmstncForm-f_011813.pdf	Form and Instruction
CMS-10250 Notice of Participation OQR_NOP final 508.docx	Form and Instruction

IC Title:

Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10250	Notice of Participation	OQR_NOP final 508.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10250	Request for Reconsideration Part 1	HosOQR_ReconFormPart1_012313.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10250	Request for Reconsideration Part 2	HosOQR_ReconFormPart_2_012313.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10250	Extroadinary Circumstances	ExtrordryCrcmstncForm-f_011813.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,200

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	16,000	16,000
Annual IC Time Burden (Hours)	2,672	2,672
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.