Quality Measures and Procedures for Hospital Reporting of Quality Data

(CMS-10210) Hospital Reporting Initiative--Hospital Quality Measures

OMB: 0938-1022

IC ID: 204350

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Quality Measures and Procedures for Hospital Reporting of Quality Data
 
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-10210 Data Accuracy and Completeness Form IQR_DACA__PY 2018_vFinal_9.2.2016.doc Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Hospital VPB Review and Corrections Form HVBP_Review_and_Corrections_Request_Form_Final_9.2.2016.doc Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Extraordinary Circumstances Form ECE Request Form Final 9.2.2016.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Inpatient Withholding Data form PR_Oct2016_IP_HCWithholdingRequestForm9.2.2016.doc Yes Yes Fillable Fileable
Form and Instruction CMS-10210 IQR Measure Exception Form IPPS_MeasureExceptionForm_9.2.2016.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 IQR Notice of Participation Form IQR NOP Text 9.2.2016.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 IQR Reconsideration Request Form QR_Form_APUReconsiderationRequest_9.2.2016_Final.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 CAUTI Validation Template FY18_CAUTI_ValTemp_9.2.2016.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 CDI Validation Template FY18_CDI_ValTemp_9.2.2016.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 CLABSI Validation Template FY18_CLABSI_ValTmplt_9.2.2016.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 MRSA Validation Template FY18_MRSA_ValTemp_9.2.2016.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Validation Review for Reconsideration Request IQR_Form_ValidnReviewReq_9.2.2016_Final.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 VBP Appeal Request Form HVBP Appeal Request Form Final 9.2.2016.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10210 HVBP CMS Independent Review Form HVBP CMS Independent Review Form_9.2.2016_Final.doc Yes Yes Fillable Fileable

Health Public Health Monitoring

 

4,400 0
   
Private Sector 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 17,600 0 0 0 0 17,600
Annual IC Time Burden (Hours) 3,681,023 0 -4,270,672 0 0 7,951,695
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk FY 2017 IPPS Final Rule Summary of HIQR PRA Information Collection Forms.docx 09/12/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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