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Federal forms, ICRs, and supporting documents

Information Collection

: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network

IC 217583 under ICR 202207-0938-011 · OMB 0938-1289.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10569 Letter to Facilities - data collection CMS_10569_CPM Request Letter to Facilities_template.docx Yes Yes Fillable Fileable
Instruction CMS_10569- Message Introducing Contractor to All Facilities_template.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10569 EQRS Global App CMS-10569 screenshots 3-30-2020.docx Yes Yes Fillable Fileable

Health Health Care Services

 

7,610 958
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 532,931 0 0 0 0 532,931
Annual IC Time Burden (Hours) 3,390,283 0 0 0 0 3,390,283
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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