Ambulatory Surgical Center Quality Reporting (ASCQR) Program

Ambulatory Surgical Center Quality Reporting Program (CMS-10530)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1270 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10530 Ambulatory Surgical Center Quality Reporting (ASCQR) Program Form and Instruction
CY 2021 ASCQR Specifications Manual.pdf Instruction
CY 2021 ASCQR Specifications Manual.pdf Instruction
CMS-10530 Data Collection insruments ASCQR Web Based Measures Data Collection Tool w PRA Notice.docx Form and Instruction
CMS-10530 Data Collection insruments ASCQR Web Based Measures Data Collection Tool w PRA Notice.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Ambulatory Surgical Center Quality Reporting (ASCQR) Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CY 2021 ASCQR Specifications Manual.pdf		Yes	No	Printable Only
Form and Instruction	CMS-10530	Data Collection insruments	ASCQR Web Based Measures Data Collection Tool w PRA Notice.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,494	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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	672,246	-121,453	793,699
Annual IC Time Burden (Hours)	176,096	-24,432	200,528
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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