Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form

Hospice Quality Reporting Program

OMB: 0938-1153

IC ID: 203679

Information Collection (IC) Details

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Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10390 Hospice Item Set - Descriptions CMS-10390 - HQRP Hospice Item Set- Item Descriptions_final.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10390 Hospice Item Set - Admissions CMS-10390 - Hospice Item Set v2 Admission w.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10390 Hospice Item Set - Discharge CMS-10390 - Hospice Item Set v2 Discharge wxx.docx Yes Yes Fillable Fileable

Health Health Care Services

 

4,259 4,046
   
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 4,259 0 0 517 0 3,742
Annual IC Time Burden (Hours) 686,631 0 0 160,804 0 525,827
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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