PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program

PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program (CMS-10431)

OMB: 0938-1175

IC ID: 202342

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1175 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10431 PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program Form and Instruction
CMS-10431 Oncology Care Measures Pop Sample application Form OCMs PopSample_application_April 17 2014_03242017 (508).docx Form and Instruction
CMS-10431 Oncology Care Measures Pop Sample application Form OCMs PopSample_application_April 17 2014_03242017 (508).docx Form and Instruction
CMS-10431 Measure Exception Form PCHQR_PRA_Measure Exception Form_CY2024_05192023_clean.docx Form and Instruction
CMS-10431 Measure Exception Form PCHQR_PRA_Measure Exception Form_CY2024_05192023_clean.docx Form and Instruction
CMS-10431 Oncology Cares Measures Paper Submission PQ 2019-01-29 V1 Data Collection - Oncology Care Measures Paper Form (PC....docx Form and Instruction
CMS-10431 Oncology Cares Measures Paper Submission PQ 2019-01-29 V1 Data Collection - Oncology Care Measures Paper Form (PC....docx Form and Instruction
CMS-10431 Data Accuracy and Completeness Form PCHQR_PRA_HQR FY2025 DACA_05192023_clean.docx Form and Instruction
CMS-10431 Data Accuracy and Completeness Form PCHQR_PRA_HQR FY2025 DACA_05192023_clean.docx Form and Instruction
CMS-10431 Notice of Participation PCH NOP Paper Form_03242017 (508).docx Form and Instruction
CMS-10431 Notice of Participation PCH NOP Paper Form_03242017 (508).docx Form and Instruction
PCHQR_PRA_Measure Exception Form_CY2024_05192023_redlined.docx Measures exception form redline IC Document
PCHQR_PRA_Measure Exception Form_CY2024_05192023_redlined.docx Measures exception form redline IC Document
PCHQR_PRA_HQR FY2025 DACA_05192023_redlined.docx Data Accuracy and Completeness Acknowledgement redline IC Document
PCHQR_PRA_HQR FY2025 DACA_05192023_redlined.docx Data Accuracy and Completeness Acknowledgement redline IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10431	Oncology Care Measures Pop Sample application	Form OCMs PopSample_application_April 17 2014_03242017 (508).docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Measure Exception Form	PCHQR_PRA_Measure Exception Form_CY2024_05192023_clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Oncology Cares Measures Paper Submission	PQ 2019-01-29 V1 Data Collection - Oncology Care Measures Paper Form (PC....docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Data Accuracy and Completeness Form	PCHQR_PRA_HQR FY2025 DACA_05192023_clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10431	Notice of Participation	PCH NOP Paper Form_03242017 (508).docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	11	0	11
Annual IC Time Burden (Hours)	109	106	3
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Measures exception form redline	PCHQR_PRA_Measure Exception Form_CY2024_05192023_redlined.docx	05/23/2023
Data Accuracy and Completeness Acknowledgement redline	PCHQR_PRA_HQR FY2025 DACA_05192023_redlined.docx	05/23/2023

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