Information Collection Request

Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb) (CMS-10569)

ICR 201708-0938-010 · OMB 0938-1289 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10569 : End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network Form and Instruction Modified Available
CMS-10569_Supporting_Statement B_CY2018.8.15.2017.doc Supporting Statement B Uploaded 2017-09-01 Available
CMS-10569 Supporting Statement A.ESRDQIP CY18 8.15.2017.docx Supporting Statement A Uploaded 2017-09-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
217583 : End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2019 36 Months From Approved 02/28/2019
773,737 0 773,737
1,917,852 0 1,917,852
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network CMS-10569 Screen shots



Reginfo record details
  No