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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Attachment F. Quality Improvement Measures.docx	Other-Quality Improvement Measures
Attachment F. Quality Improvement Measures.docx	Other-Quality Improvement Measures

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:

table that charts list of 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 %

table that charts list of burden
	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

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.