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National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP)
National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) (CMS-10639)
OMB: 0938-1340
IC ID: 224551
OMB.report
HHS/CMS
OMB 0938-1340
ICR 202308-0938-008
IC 224551
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1340 can be found here:
2024-01-19 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
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
CMS-10639 Request Letter to Facilities Records
CMS_10639_NHSN Request Letter to Facilities_Records_Template.docx
Form and Instruction
CMS-10639 Request Letter to Facilities - List
CMS-10639_NHSN Request Letter to Facilities_List_Template.docx
Form and Instruction
CMS_10639_Message Introducing Contractor to All Facilities_template.docx
Contractor Letter
IC Document
Information Collection (IC) Details
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