Information Collection

(CMS-10685) E-mail Feedback Regarding Psychiatric Facility Quality Measure Strategies

IC 233421 under ICR 201611-0938-004 · OMB 0938-1185.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1185 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10685 (CMS-10685) E-mail Feedback Regarding Psychiatric Facility Quality Measure Strategies	Form and Instruction
CMS-10685 LAN member best practices email D1 LAN Member Best Practices Email.docx	Form and Instruction
CMS-10685 Generic_Clearance_Submission_Template_D1V_IPF_Measure_Feedback.doc CMS-10685 GenIC Supporting Statement	IC Document

IC Title:

(CMS-10685) E-mail Feedback Regarding Psychiatric Facility Quality Measure Strategies

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10685	LAN member best practices email	D1 LAN Member Best Practices Email.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 179

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	179	179
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10685 GenIC Supporting Statement	CMS-10685 Generic_Clearance_Submission_Template_D1V_IPF_Measure_Feedback.doc	10/04/2018

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