Information Collection Request

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

ICR 201603-0938-010 · OMB 0938-1109 · Historical Active

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 Modified 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 CY 2016 OPPS-ASC Final Rule-Hospit....doc Supporting Statement B Uploaded 2016-06-23 Available
CMS-10250 Supporting Statement Part A CY 2016 OPPS-ASC Final Rule-Hospit....doc Supporting Statement A Uploaded 2016-06-23 Available

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2017 36 Months From Approved 01/31/2017
2,331,486 0 5,115,060
3,056,717 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 - Data Validation (CY 2014)
Hospital Outpatient Quality Data Program - Data Validation (CY 2015)
Hospital Outpatient Quality Data Program - Administrative (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 - Notice of Participation Web based (CY 2017)
Hospital Outpatiennt Quality Data Program - Data Validation (CY 2017)

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 2,331,486 5,115,060 0 -2,783,574 0 0
Annual Time Burden (Hours) 3,056,717 6,060,452 0 -3,003,735 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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