Inpatient Psychiatric Facility Quality Reporting Program

Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

OMB: 0938-1171

IC ID: 202349

Information Collection (IC) Details

View Information Collection (IC)

Inpatient Psychiatric Facility Quality Reporting Program
 
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-10432 IPF Data Accuracy Form CMS IPF DACA Paper Form_FY2020 v2.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10432 HBIPS Measures Data Collection Tool CMS IPF HBIPS Data collection paper form_FY2020 v2.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Vendor Authorization Form CMS IPF Vendor Auth_paperform_FY2020 v2.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Online Data Entry Tool Content for Structural Measures EHR Pt Experience 2019.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 FY 2019 Non-Measure Data Collection Paper Tool Non Measure Data Collection Tool v2.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10432 IPF Screen shots IPF Screen Shots_08_02_2016.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Notice of Participation IPFQR_NOP_FY2020.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Online Data Entry Tool Content for Web-Based Measure Collection IPFQR Web-Based Submissions v2.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Screening for Metabolic Disorders Screening for Metabolic Disorders collection form FY 2020 v2.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Transitions Measures Collection Form Data Collection Tool for Transition Record Measures v2.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10432 Substance Use Measure Collection IPF_FY2020 SUB_form.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,734 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 1,470,432 0 41,177 1,223 0 1,428,032
Annual IC Time Burden (Hours) 2,944,332 0 -1,802,722 84,900 0 4,662,154
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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