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End Stage Renal Disease Quality Reporting System (EQRS) Customer Satisfaction and Task Prioritization Survey for the EQRS Release 1.0 Project (CMS-10626)

IC 235896 under ICR 201904-0938-017 · OMB 0938-1185.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

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End Stage Renal Disease Quality Reporting System (EQRS) Customer Satisfaction and Task Prioritization Survey for the EQRS Release 1.0 Project (CMS-10626)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10626 CrownWeb Facility User Survey CMS-10626 PRA_Generic_Clearance_Submission_EQRS_Facility_Dashboard_Survey_revised2.docx Yes Yes Fillable Fileable

Health Health Care Services

 

200 15
   
Private Sector Businesses or other for-profits
 
   0 %

  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 200 0 200 0 0 0
Annual IC Time Burden (Hours) 50 0 50 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10626 PRA_Generic_Clearance_Submission_EQRS_Facility_Dashboard_Survey_revised2 CMS-10626 PRA_Generic_Clearance_Submission_EQRS_Facility_Dashboard_Survey_revised2.docx 04/30/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.