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PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program
PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program (CMS-10431)
OMB: 0938-1175
IC ID: 202342
OMB.report
HHS/CMS
OMB 0938-1175
ICR 202308-0938-011
IC 202342
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1175 can be found here:
2024-05-22 - Revision of a currently approved collection
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 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 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
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
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:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
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 %
Approved
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
11
0
0
0
0
11
Annual IC Time Burden (Hours)
109
0
106
0
0
3
Annual IC Cost Burden (Dollars)
0
0
0
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.