Information Collection Request

Hospital Outpatient Quality Data Program (HOPQDRP) (CMS-10250)

ICR 201508-0938-011 · OMB 0938-1109 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10250 Hospital Outpatient Quality Reporting CY 2016 - CY 2018 Form and Instruction New Available
Form CMS-10250 Hospital Outpatient Quality Program - Notice of Participation (CY 2016) Form and Instruction Removed Available
Form CMS-10250 Hospital Outpatient Quality Data Program - Notice of Participation (CY 2015) Form and Instruction Removed Available
Form CMS-10250 Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014) Form and Instruction Removed Available
CMS-10250 Supporting Statement Part B 06_01_2015 CLEAN.pdf Supporting Statement B Uploaded 2015-08-25 Available
CMS-10250 Supporting Statement Part A 07_01_2015 CLEAN.pdf Supporting Statement A Uploaded 2015-08-25 Available

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2017 36 Months From Approved 01/31/2017
5,115,060 0 5,115,060
6,060,452 0 6,060,452
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
Hospital Outpatient Quality Data Program - Notice of Participation Web based (CY 2017)
Hospital Outpatiennt Quality Data Program - Data Validation (CY 2017)
Hospital Outpatient Quality Data Program -Web based OP-31 (CY 2017)
Hospital Outpatient Quality Reporting CY 2016 - CY 2018 CMS-10250, CMS-10250, CMS-10250, CMS-10250 Extroadinary Circumstances Form ,   Notice of Participation Form ,   Validation Review for Reconsideration Request ,   Reconsideration Request Form
Hospital Outpatient Quality Data Program - Data Abstraction (CY 2015)
Hospital Outpatient Quality Data Program - Data Abstraction (CY 2014)
Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014) CMS-10250, CMS-10250, CMS-10250, CMS-10250 Request for Reconsideration Part 1 ,   Request for Reconsideration Part 2 ,   Extroadinary Circumstances ,   Notice of Participation
Hospital Outpatient Quality Data Program - Notice of Participation (CY 2015) CMS-10250 Notice of Participation
Hospital Outpatient Quality Data Program - Data Abstration (CY 2016)
Hospital Outpatient Quality Program - Notice of Participation (CY 2016) CMS-10250 Notice of Participation
Hospital Outpatient Quality Data Program - Data Validation (CY 2016)
Hospital Outpatient Quality Data Program -- Data Abstration (CY 2017)
Hospital Outpatient Quality Data Program - Data Validation (CY 2015)
Hospital Outpatient Quality Data Program - Data Validation (CY 2014)
Hospital Outpatient Quality Data Program - Administrative (CY 2017)



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