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 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10804 (CMS-10804) QPP Site Intercept Survey Form and Instruction New Available
Form CMS-10800 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800) Form and Instruction New Available
CMS10706_SuppStmt_Part A_508_6-20-20.docx Supporting Statement A Uploaded 2020-09-11 Missing upstream

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
251182 (CMS-10804) QPP Site Intercept Survey Form and Instruction New
250773 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800) Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
11,476 0
4,957 0
425,509 0






table that charts list of burden
  Total Request 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