Information Collection

. Learning Collaborative QI Measures – pull and submit

IC 243381 under ICR 202008-0935-001 · OMB 0935-0258.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0258 can be found here:

Documents and Forms

Document Name Document Type
Attachment F. Quality Improvement Measures.docx Other-Quality Improvement Measures
Attachment F. Quality Improvement Measures.docx Other-Quality Improvement Measures

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	. Learning Collaborative QI Measures â pull and submit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Quality Improvement Measures			Attachment F. Quality Improvement Measures.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	480	480
Annual IC Cost Burden (Dollars)	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.