Information Collection Request

National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) (CMS-10639)

ICR 202211-0938-005 · OMB 0938-1340 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1340 can be found here:

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Form CMS-10639 National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP)	Form and Instruction	Unchanged	Available
Form CMS-10639 National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP)	Form and Instruction	Unchanged	Available
CMS-10639 Supporting Statement B NHSN CY 2023 (10-20-2022).docx	Supporting Statement B	Uploaded 2022-11-09	Available
CMS-10639 Supporting Statement B NHSN CY 2023 (10-20-2022).docx	Supporting Statement B	Uploaded 2022-11-09	Available
CMS-10639 Supporting Statement A NHSN CY 2023 (10-20-2022).docx	Supporting Statement A	Uploaded 2022-11-09	Available
CMS-10639 Supporting Statement A NHSN CY 2023 (10-20-2022).docx	Supporting Statement A	Uploaded 2022-11-09	Repair queued

Information collection document groups
IC ID	Collection	Type	Status	Form
224551	National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP)	Form and Instruction	Unchanged
224551	National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP)	Form and Instruction	Unchanged

Record metadata
Status	Active
Agency/Subagency	HHS/CMS
OMB Control No	0938-1340
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202207-0938-012
Agency Tracking No	CCSQ
Date Submitted to OIRA	2022-11-10
Requested Expiration Date	1969-12-31