Information Collection

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

IC 263180 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⚠️ Notice: This information collection may be referencing outdated material.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 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revision))	Form and Instruction
CMS-10800 Single Ease Question for User Insights on Hospital Quali CMS-10800 Generic Clearance_07192021_HQR_Touchpoints_REVISEDOct2023.docx	Form and Instruction
CMS-10800 Generic Clearance_07192021_HQR_tracked changes_REVISEDNov1_2023.docx CMS-10800 tracked changed Supporting Statement	IC Document
CMS-10800 Generic Clearance_07192021_HQR_Touchpoints_REVISEDOct2023.docx Supporting Statement	IC Document

IC Title:

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

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				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 tracked changed Supporting Statement		11/02/2023
Supporting Statement		11/02/2023

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].