Information Collection Request
ICR 202107-0938-001 · OMB 0938-1424 · Public filing
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1424 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10769 HQIC Hospital Survey |
Form and Instruction | New | Repair queued |
| Form CMS-10769 NQIIC Nursing Home Survey |
Form and Instruction | New | Repair queued |
 CMS-10769_Crosswalk_for_30_Day_Package_Changes_v4_508.pdf |
Supplementary Document | Uploaded 2021-07-02 | Repair queued |
 CMS-10769_Response_to_Comments_Received_2021-06-07.docx |
Supplementary Document | Uploaded 2021-07-02 | Repair queued |
| CMS-10769_Sup_Statement_Part_B 6-7-21.docx |
Supporting Statement B | Uploaded 2021-07-02 | Repair queued |
| Supporting_Statement_A_7.06.21.docx |
Supporting Statement A | Uploaded 2021-07-06 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 248181 |  HQIC Hospital Survey |
Form and Instruction | New | |
| 248179 | NQIIC Nursing Home Survey |
Form and Instruction | New |
ICR Details
| OMB Control No | 0938-1424 |
|---|