Inpatient Psychiatric Facility Quality Reporting Program

Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

OMB: 0938-1171

IC ID: 202349

Information Collection (IC) Details

View Information Collection (IC)

Inpatient Psychiatric Facility Quality Reporting Program
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10432 IPF Data Accuracy Form CMS IPF DACA Paper Form_FY2019.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 HBIPS Measures Data Collection Tool CMS IPF HBIPS Data collection paper form_FY2019.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Vendor Authorization Form CMS IPF Vendor Auth_paperform_FY2018.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Online Data Entry Tool Content for Structural Measures EHR Pt Experience 2019.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 FY 2019 Non-Measure Data Collection Paper Tool FY 2018 IPF_FY2016_NonMeasureData_PprTool_20150701_FINAL(508) (2).docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Substance Use Measure Collection IPF_FY2019 SUB_form.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Notice of Participation IPFQR_NOP_FY2015.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Online Data Entry Tool Content for Web-Based Measure Collection Screening for Metabolic Disorders collection form FY 2019.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 TOB IMM Collection Form TOB IMM collection form FY 2019.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Transitions Measures Collection Form Transition Measure collection form FY 2019.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 IPF Screen shots IPF Screen Shots_08_02_2016.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,684 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,428,032 0 755,360 0 0 672,672
Annual IC Time Burden (Hours) 4,657,944 0 3,174,184 0 0 1,483,760
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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