Information Collection Request

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

ICR 201910-0938-003 · OMB 0938-1175 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10431 PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program Form and Instruction Modified Available
CMS-10431 Supporting Statement A - FY 2020 Final Rule (PCHQR).docx Supporting Statement A Uploaded 2019-10-24 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
202342 PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2022 36 Months From Approved 01/31/2022
142,406 0 108,500
75,779 0 75,782
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431 EBRT Pop Sample Application ,   EBRT Paper based ,   Oncology Care Measures Pop Sample application ,   Measure Exception Form ,   Oncology Cares Measures Paper Submission ,   Data Accuracy and Completeness Form ,   Notice of Participation

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 142,406 108,500 0 0 33,906 0
Annual Time Burden (Hours) 75,779 75,782 0 -3 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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