Information Collection Request

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

ICR 201811-0938-005 · OMB 0938-1289 · Historical Active

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 A CROWNWeb CY 2019 (10-25-18).docx Supporting Statement A Uploaded 2018-11-15 Available
CMS-10569 Supporting Statement B CROWNWeb CY 2019 (10-25-18).docx Supporting Statement B Uploaded 2018-11-15 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
11/30/2021 36 Months From Approved 02/28/2019
509,938 0 497,542
3,097,383 0 2,883,626
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 Letter to Facilities - data collection

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 509,938 497,542 0 12,396 0 0
Annual Time Burden (Hours) 3,097,383 2,883,626 0 213,757 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No