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⚠️ Notice: This information collection may be referencing outdated material.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
FY 2018 IPF_FY2016_NonMeasureData_PprTool_20150701_FINAL(508).docx Instruction
CMS-10432 SUB-1 Measure SUB collection form FY2018 Passback_Program Responses v3 -- CLEAN.pdf Form
CMS-10432 TOB & IMM Measures TOB IMM collection form FY 2018.docx Form
CMS-10432 EHR & Patient Exp of Care Measures EHR Pt Experience 2018 Passback_Program Responses v3 -- CLEAN.pdf Form
CMS-10432 Transition Record Measures Transfer Measure collection form FY 2018.pdf Form
CMS-10432 Screening for Metabolic Disorders Measure Screening for Metabolic Disorders collection form FY 2018.docx Form

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	CMS-10432	TOB & IMM Measures	TOB IMM collection form FY 2018.docx	Yes	Yes	Fillable Printable
Form	CMS-10432	Screening for Metabolic Disorders Measure	Screening for Metabolic Disorders collection form FY 2018.docx	Yes	Yes	Fillable Printable
Instruction			FY 2018 IPF_FY2016_NonMeasureData_PprTool_20150701_FINAL(508).docx	Yes	Yes	Fillable Printable
Form	CMS-10432	EHR & Patient Exp of Care Measures	EHR Pt Experience 2018 Passback_Program Responses v3 -- CLEAN.pdf	Yes	Yes	Fillable Printable
Form	CMS-10432	SUB-1 Measure	SUB collection form FY2018 Passback_Program Responses v3 -- CLEAN.pdf	Yes	Yes	Fillable Printable
Form	CMS-10432	Transition Record Measures	Transfer Measure collection form FY 2018.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,617	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	672,672	-115,692	-115,692	904,056
Annual IC Time Burden (Hours)	1,483,760	-227,623	-227,622	1,939,005
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

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.