Information Collection

Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)

IC 209855 under ICR 201603-0938-010 · OMB 0938-1109.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1109 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10250 Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014) Form and Instruction
CMS-10250 Request for Reconsideration Part 1 HosOQR_ReconFormPart1_012313.pdf Form and Instruction
CMS-10250 Request for Reconsideration Part 2 HosOQR_ReconFormPart_2_012313.pdf Form and Instruction
CMS-10250 Extroadinary Circumstances ExtrordryCrcmstncForm-f_011813.pdf Form and Instruction
CMS-10250 Notice of Participation OQR_NOP final 508.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10250	Request for Reconsideration Part 1	HosOQR_ReconFormPart1_012313.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10250	Request for Reconsideration Part 2	HosOQR_ReconFormPart_2_012313.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10250	Extroadinary Circumstances	ExtrordryCrcmstncForm-f_011813.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10250	Notice of Participation	OQR_NOP final 508.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,200	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 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-16,000	16,000
Annual IC Time Burden (Hours)	-2,672	2,672
Annual IC Cost Burden (Dollars)	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.