PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program

PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program (CMS-10431)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CMS-10431 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 PQ 2019-01-29 V1 Data Collection - Oncology Care Measures Paper Form (PCHQR).docx Form and Instruction
CMS-10431 Data Accuracy and Completeness Form PCHQR_FY2020 DACA_01222019.docx Form and Instruction
CMS-10431 Notice of Participation PCH NOP Paper Form_03242017 (508).docx Form and Instruction

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10431	Oncology Care Measures Paper Submission	Form OCMs_PopSamp_paperbased_ April 17 2014_03242017 (508)[2].docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	EBRT Pop Sample Application	Form EBRT_webapplication_July_24_2014_03242017 (508).docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	EBRT Paper based	Form EBRT_PopSamp_paperbased_ July_22_2014_03242017 (508).docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Oncology Care Measures Pop Sample application	Form OCMs PopSample_application_April 17 2014_03242017 (508).docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Measure Exception Form	PCH Measure Exception Form_01022014_updated_03242017 (508).docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Oncology Cares Measures Paper Submission	PQ 2019-01-29 V1 Data Collection - Oncology Care Measures Paper Form (PCHQR).docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Data Accuracy and Completeness Form	PCHQR_FY2020 DACA_01222019.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Notice of Participation	PCH NOP Paper Form_03242017 (508).docx	Yes	Yes	Fillable Fileable

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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	108,500	0	108,500
Annual IC Time Burden (Hours)	75,779	-3	75,782
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.