Information Collection
NQIIC Nursing Home Survey
IC 248179 under ICR 202107-0938-001 · OMB 0938-1424.
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1424 can be found here:
Documents and Forms
| Document Name | Document Type |
|---|---|
Form CMS-10769NQIIC Nursing Home Survey |
Form and Instruction |
CMS-10769 NQIIC Nursing Home SurveyCMS-10769_App_A_NQIIC_Nursing_Home_Survey_Instrument v2_508.pdf | Form and Instruction |
CMS-10769_App_C.1_Survey_Pre-Notification_NH_Communication.docxSurvey Pre-notification Letter | IC Document |
|
CMS-10769_App_C.2_Nursing_Home_follow-up_VM_and_email_1_8_21.docx Nursing Home Follow-up Email | IC Document |
|
CMS-10769_Crosswalk_NursingHome_Survey_Questions_(QIN-QIO)_v2_508.pdf Crosswalk of Nursing Home Survey | IC Document |
Information Collection (IC) Details
| IC Title | NQIIC Nursing Home Survey |
|---|