Information Collection Request

Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

ICR 201508-0938-004 · OMB 0938-1171 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10432 Inpatient Psychiatric Facility Quality Reporting Program Form Modified Available
CMS-10432 - Supporting Statement A - Passback_Program Responses_v5 -- CLEAN.docx Supporting Statement A Uploaded 2016-07-14 Available

IC Document Collections

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

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2019 36 Months From Approved 09/30/2017
672,672 0 904,056
1,483,760 0 1,939,005
0 0 0





Reginfo record details
1
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, CMS-10432, CMS-10432 TOB & IMM Measures ,   Screening for Metabolic Disorders Measure ,   EHR & Patient Exp of Care Measures ,   SUB-1 Measure ,   Transition Record Measures

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 672,672 904,056 0 -115,692 -115,692 0
Annual Time Burden (Hours) 1,483,760 1,939,005 0 -227,623 -227,622 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No