Information Collection Request

Quality Improvement Strategy Implementation Plan and Progress Report (CMS-10540)

ICR 202012-0938-010 · OMB 0938-1286 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10540 2020 QIS Progress Report Form and Instruction Modified Available
Form cms-10540 2022 Modification Summary Supplement Form and Instruction Modified Available
Form CMS-10540 QIS-Implementation-Plan Form and Instruction Modified Available
Form CMS-10540 Quality Improvement Strategy Implementation Plan and Progress Report Form Form and Instruction Modified Repair queued
CMS-10540 - Response to 60-day comment.docx Supplementary Document Uploaded 2020-12-18 Repair queued
CMS-10540- QIS 30 day Supporting_Statementf.docx Supporting Statement A Uploaded 2020-12-18 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
217708 Quality Improvement Strategy Implementation Plan and Progress Report Form Form and Instruction Modified2020 QIS Progress Report
217708 Quality Improvement Strategy Implementation Plan and Progress Report Form Form and Instruction Modified2022 Modification Summary Supplement
217708 Quality Improvement Strategy Implementation Plan and Progress Report Form Form and Instruction ModifiedQIS-Implementation-Plan
217708 Quality Improvement Strategy Implementation Plan and Progress Report Form Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/29/2024 36 Months From Approved 02/28/2021
250 0 250
11,000 0 24,000
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Quality Improvement Strategy Implementation Plan and Progress Report Form CMS-10540, cms-10540, CMS-10540 ,   ,  

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 250 250 0 0 0 0
Annual Time Burden (Hours) 11,000 24,000 0 0 -13,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No