Information Collection Request
Hospice Quality Reporting Program (CMS-10390)
ICR 202211-0938-006 · OMB 0938-1153 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1153 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10390 Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form |
Form and Instruction | Modified | Repair queued |
 CMS-1754-F - Supporting Statement Final.docx |
Supporting Statement A | Uploaded 2022-11-14 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 203679 |  Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1153 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202104-0938-013 |
| Agency Tracking No | CCSQ |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |