Information Collection Request

Generic Clearance for the Center for Clinical Standards and Quality IT Product and Support Teams (CMS-10706)

ICR 202009-0938-002 · OMB 0938-1397 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10896 CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey Form and Instruction New Repair queued
Form CMS-10886 CCSQ Support Central Knowledge Research Survey Form and Instruction New Repair queued
Form CMS-10838 Submissions Intercept Survey Instrument Form and Instruction New Repair queued
Form CMS-10838 Submissions Intercept Survey Instrument Form and Instruction New Repair queued
Form CMS-10800 Single Ease Question for User Insights on Hospital Quality Reporting Form and Instruction New Repair queued
Form CMS-10871 HQR User Language Card Sort Form and Instruction New Repair queued
Form CMS-10817 HQR User Research Participation Survey Form and Instruction New Repair queued
Form CMS-10838 Submissions Intercept Survey Questions Form and Instruction New Repair queued
Form CMS-10832 Support Central Screen shot Form and Instruction New Repair queued
Form CMS-10833 QPP Customer Effort Questionnaire: 2020 Online Survey Form and Instruction New Repair queued
Form CMS-10833 QualityNet Help Desk Customer Feedback Survey Form and Instruction New Repair queued
Form CMS-10833 QualityNet-EQRS Help Desk Customer Feedback Survey Form and Instruction New Repair queued
Form CMS-10818 Track Existing Ticket Form and Instruction New Repair queued
Form CMS-10818 Live Chat Form and Instruction New Repair queued
Form CMS-10818 Create a Ticket Form and Instruction New Repair queued
Form CMS-10818 Call Scheduling Form and Instruction New Repair queued
Form CMS-10817 HQR User Research Participation Survey Form and Instruction New Repair queued
Form CMS-10810 Idea Portal Form and Instruction New Repair queued
Form CMS-10808 iQies HCD User Research Form Form and Instruction New Repair queued
Form CMS-10804 QPP Intercept Survey Form and Instruction New Available
Form CMS-10800 HQR Touchpoints Survey Form and Instruction New Available
CMS10706_SuppStmt_Part A_508_6-20-20.docx Supporting Statement A Uploaded 2020-09-11 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
266552 CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) Form and Instruction NewCCSQ Support Central Live Chat and Virtual Agent Enhancement Survey
264375 CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) Form and Instruction NewCCSQ Support Central Knowledge Research Survey
264008 PY 23 QPP Submissions Intercept Survey (CMS-10838) Form and Instruction NewSubmissions Intercept Survey Instrument
264008 PY 23 QPP Submissions Intercept Survey (CMS-10838) Form and Instruction NewSubmissions Intercept Survey Instrument
263180 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revision)) Form and Instruction NewSingle Ease Question for User Insights on Hospital Quality Reporting
261961 Hospital Quality Reporting User Language Card Sort (CMS-10871) Form and Instruction NewHQR User Language Card Sort
260963 Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) Form and Instruction NewHQR User Research Participation Survey
257263 QPP Submissions Intercept Survey (CMS-10838) Form and Instruction NewSubmissions Intercept Survey Questions
256241 Chat/CCSQ Support Central – Basic information questions (CMS-10832) Form and Instruction NewSupport Central Screen shot
256239 Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction NewQPP Customer Effort Questionnaire: 2020 Online Survey
256239 Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction NewQualityNet Help Desk Customer Feedback Survey
256239 Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction NewQualityNet-EQRS Help Desk Customer Feedback Survey
254797 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction NewTrack Existing Ticket
254797 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction NewLive Chat
254797 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction NewCreate a Ticket
254797 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction NewCall Scheduling
254525 Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817) Form and Instruction NewHQR User Research Participation Survey
254129 Internet Quality Improvement and Evaluation System (IQIES) Idea Portal Form and Instruction NewIdea Portal
251990 Internet Quality Improvement and Evaluation System (IQIES) HCD User Research Form (CMS-10808) Form and Instruction NewiQies HCD User Research Form
251182 (CMS-10804) QPP Site Intercept Survey Form and Instruction NewQPP Intercept Survey
250773 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800) Form and Instruction NewHQR Touchpoints Survey

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2024 36 Months From Approved
11,476 0 0
4,957 0 0
425,509 0 0





Reginfo record details
15
table that charts list of burden
IC Title Form No. Form Name
(CMS-10804) QPP Site Intercept Survey CMS-10804
CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) CMS-10886
CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) CMS-10896
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) CMS-10818 , CMS-10818, CMS-10818 , CMS-10818 ,   ,   ,  
Chat/CCSQ Support Central – Basic information questions (CMS-10832) CMS-10832
Customer Effort Scoring - Surveys (CMS-10833) CMS-10833, CMS-10833, CMS-10833 ,   ,  
Hospital Quality Reporting User Language Card Sort (CMS-10871) CMS-10871
Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817) CMS-10817
Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) CMS-10817
Internet Quality Improvement and Evaluation System (IQIES) HCD User Research Form (CMS-10808) CMS-10808
Internet Quality Improvement and Evaluation System (IQIES) Idea Portal CMS-10810
PY 23 QPP Submissions Intercept Survey (CMS-10838) CMS-10838, CMS-10838 ,  
QPP Submissions Intercept Survey (CMS-10838) CMS-10838
Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revision)) CMS-10800
Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800) CMS-10800

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 11,476 0 0 11,476 0 0
Annual Time Burden (Hours) 4,957 0 0 4,957 0 0
Annual Cost Burden (Dollars) 425,509 0 0 425,509 0 0


Reginfo record details
  No