Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form

Hospice Quality Reporting Program (CMS-10390)

OMB: 0938-1153

IC ID: 203679

Information Collection (IC) Details

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Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10390 Hospice Item Set - Descriptions CMS-10390 - HQRP Hospice Item Set- Item Descriptions.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10390 Hospice Item Set - Admissions CMS-10390 - HQRP HIS Admissions_F.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10390 Hospice Item Set - Discharge CMS-10390 - HQRP-HIS-v3000-Discharge_CMS-F.pdf Yes Yes Fillable Fileable
Instruction HQRP QM Users Manual V.4_8.07.20_508c_toCMS.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

4,688 4,046
   
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 4,688 0 0 0 0 4,688
Annual IC Time Burden (Hours) 636,312 0 0 0 0 636,312
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.

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