: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network

(CMS-10569) Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb)

OMB: 0938-1289

IC ID: 217583

Information Collection (IC) Details

View Information Collection (IC)

: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10569 Pain Assessment Screenshot CW4.8_Pain Assessment_Screenshot.png Yes Yes Fillable Fileable
Form and Instruction CMS-10569 HD Clinical Page 4.6 HD Clinical Page.PNG Yes Yes Fillable Fileable
Form and Instruction CMS-10569 PD Clinical Page 4.6 PD Clinical Page.PNG Yes Yes Fillable Fileable
Form and Instruction CMS-10569 Clinical Depression Screenshot CW4.8_Clinical Depression_Screenshot.png Yes Yes Fillable Fileable

Health Health Care Services

 

6,264 958
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 773,737 0 773,737 0 0 0
Annual IC Time Burden (Hours) 985,741 0 985,741 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HMS Letter to non-respondents HMS Letter to Non-Respondents.docx 07/21/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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