Information Collection Request

Hospital Outpatient Quality Data Program (HOPQDRP) (CMS-10250)

ICR 202302-0938-013 · OMB 0938-1109 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10250 Web Based Data Collection Tool Form and Instruction Modified Available
Form CMS-10250 Validation Review for Reconsideration Request Form and Instruction Modified Available
Form CMS-10250 Hospital Outpatient Quality Reporting Form and Instruction Modified Repair queued
CMS-10250.SupportingStatementPartB (final rule).docx Supporting Statement B Uploaded 2023-02-16 Repair queued
CMS-10250.SupportingStatementPartA (final rule).docx Supporting Statement A Uploaded 2023-02-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
217995 Hospital Outpatient Quality Reporting Form and Instruction ModifiedWeb Based Data Collection Tool
217995 Hospital Outpatient Quality Reporting Form and Instruction ModifiedValidation Review for Reconsideration Request
217995 Hospital Outpatient Quality Reporting Form and Instruction Modified
217995 Hospital Outpatient Quality Reporting Instruction Modified

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2025 36 Months From Approved 02/28/2025
968,150 0 953,700
291,604 0 907,670
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
Hospital Outpatient Quality Reporting CMS-10250, CMS-10250 ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 968,150 953,700 0 0 14,450 0
Annual Time Burden (Hours) 291,604 907,670 0 0 -616,066 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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