Information Collection

Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800)

IC 250773 under ICR 202009-0938-002 · OMB 0938-1397.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1397 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10800 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800)	Form and Instruction
CMS-10800 HQR Touchpoints Survey CMS-10800 Generic Clearance_HQR_Touchpoints_12-14-21.docx	Form and Instruction
CMS-10800 Generic Clearance_HQR_Touchpoints_12-14-21.docx CMS-10800 Gen IC	IC Document

IC Title:

Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800)

Agency IC Tracking Number:

CCSQ

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
Form and Instruction	CMS-10800	HQR Touchpoints Survey	CMS-10800 Generic Clearance_HQR_Touchpoints_12-14-21.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10800 Gen IC	CMS-10800 Generic Clearance_HQR_Touchpoints_12-14-21.docx	12/14/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.