Information Collection

Hospital Outpatient Quality Reporting

IC 217995 under ICR 201911-0938-015 · OMB 0938-1109.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1109 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10250 Hospital Outpatient Quality Reporting	Form and Instruction
OQR_Specifications_Manual_13.0.pdf	Instruction
CMS-10250 Validation Review for Reconsideration Request OQR_Form_ValidnReviewReq_CY 2019.pdf	Form and Instruction

IC Title:

Hospital Outpatient Quality Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10250	Validation Review for Reconsideration Request	OQR_Form_ValidnReviewReq_CY 2019.pdf		Yes	Yes	Fillable Fileable
Instruction			OQR_Specifications_Manual_13.0.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,125,100	0	3,125,100
Annual IC Time Burden (Hours)	1,387,119	-551	1,387,670
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.