Information Collection

PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program

IC 202342 under ICR 201705-0938-015 · OMB 0938-1175.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1175 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10431 Oncology Care Measures Paper Submission PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction
Form CMS-10431 EBRT Pop Sample Application PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction
Form CMS-10431 EBRT Paper based PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction
Form CMS-10431 Oncology Care Measures Pop Sample application PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction
Form CMS-10431 Measure Exception Form PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction
Form CMS-10431 Oncology Cares Measures Paper Submission PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction
Form CMS-10431 Data Accuracy and Completeness Form PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction
Form CMS-10431 Notice of Participation PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction
CMS-10431 Oncology Care Measures Paper Submission Form OCMs_PopSamp_paperbased_ April 17 2014_03242017 (508)[2].docx	Form and Instruction
CMS-10431 EBRT Pop Sample Application Form EBRT_webapplication_July_24_2014_03242017 (508).docx	Form and Instruction
CMS-10431 EBRT Paper based Form EBRT_PopSamp_paperbased_ July_22_2014_03242017 (508).docx	Form and Instruction
CMS-10431 Oncology Care Measures Pop Sample application Form OCMs PopSample_application_April 17 2014_03242017 (508).docx	Form and Instruction
CMS-10431 Measure Exception Form PCH Measure Exception Form_01022014_updated_03242017 (508).docx	Form and Instruction
CMS-10431 Oncology Cares Measures Paper Submission Data Collection - Oncology Care Measures Paper Form (508).docx	Form and Instruction
CMS-10431 Data Accuracy and Completeness Form PCH DACA Form_03_31_2016_03242017 (508).docx	Form and Instruction
CMS-10431 Notice of Participation PCH NOP Paper Form_03242017 (508).docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10431	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	325,501	-75,130	400,631
Annual IC Time Burden (Hours)	158,887	-41,538	200,425
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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