Ambulatory Surgical Center Quality Reporting (ASCQR) Program

(CMS-10530) Ambulatory Surgical Center Quality Reporting Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1270 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10530 Ambulatory Surgical Center Quality Reporting (ASCQR) Program Form and Instruction
CMS-10530 Extroadinary Circumstance Online Form Extraordinary Circumstance Online Form_update_07152014_CLB_v10212014.docx Form and Instruction
CMS-10530 Reconsideration Request Online Form ReconsiderationRequest Online Form_update_07152014_CLB_10222014.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Ambulatory Surgical Center Quality Reporting (ASCQR) 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10530	Extroadinary Circumstance Online Form	Extraordinary Circumstance Online Form_update_07152014_CLB_v10212014.docx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10530	Reconsideration Request Online Form	ReconsiderationRequest Online Form_update_07152014_CLB_10222014.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,260	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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,407,576	662,760	744,816
Annual IC Time Burden (Hours)	367,711	-77,079	444,790
Annual IC Cost Burden (Dollars)	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.