Ambulatory Surgical Center Quality Reporting (ASCQR) Program

Ambulatory Surgical Center Quality Reporting Program (CMS-10530)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1270 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10530 Ambulatory Surgical Center Quality Reporting (ASCQR) Program Form and Instruction
CMS-10530. 12.0_ASC_Full_Specs_Mnl (1).pdf Instruction
CMS-10530. 12.0_ASC_Full_Specs_Mnl (1).pdf Instruction
CMS-10530 Data Collection insruments CMS-10530 ASCQR data submission tool 9-10-21.pdf Form and Instruction
CMS-10530 Data Collection insruments CMS-10530 ASCQR data submission tool 9-10-21.pdf Form and Instruction
CMS-10530.CMS Qual CMS-10530.CMS Quality Program ECE Request Form_CY 2024_v CMS-10530.CMS Quality Program ECE Request Form_CY 2024_vFinal.docx Form and Instruction
CMS-10530.CMS Qual CMS-10530.CMS Quality Program ECE Request Form_CY 2024_v CMS-10530.CMS Quality Program ECE Request Form_CY 2024_vFinal.docx Form and Instruction
CMS-10530.ASCQR_Wi CMS-10530.ASCQR_Withdraw Form CMS-10530.ASCQR_Withdraw Form.docx Form and Instruction
CMS-10530.ASCQR_Wi CMS-10530.ASCQR_Withdraw Form CMS-10530.ASCQR_Withdraw Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Ambulatory Surgical Center Quality Reporting (ASCQR) Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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-10530	Data Collection insruments	CMS-10530 ASCQR data submission tool 9-10-21.pdf	Yes	Yes	Fillable Fileable
Instruction			CMS-10530. 12.0_ASC_Full_Specs_Mnl (1).pdf	Yes	No	Printable Only
Form and Instruction	CMS-10530.CMS Quality Program ECE Request Form_CY	CMS-10530.CMS Quality Program ECE Request Form_CY 2024_vFinal	CMS-10530.CMS Quality Program ECE Request Form_CY 2024_vFinal.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10530.ASCQR_Withdraw Form	CMS-10530.ASCQR_Withdraw Form	CMS-10530.ASCQR_Withdraw Form.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,057	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	1,294,592	105,216	1,189,376
Annual IC Time Burden (Hours)	58,060	6,902	51,158
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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