Information Collection Request

Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb) (CMS-10569)

ICR 202401-0938-005 · OMB 0938-1289 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10569 EQRS Global App Form and Instruction Modified Available
Form CMS-10569 Letter to Facilities - data collection Form and Instruction Modified Available
Form CMS-10569 : End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network Form and Instruction Modified Repair queued
CMS-10569 Supporting Statement A EQRS CY 2024 (10-26-2023).docx Supporting Statement A Uploaded 2024-01-19 Available
CMS-10569 Supporting Statement A EQRS CY 2024 (10-26-2023).docx Supporting Statement A Uploaded 2024-01-19 Repair queued
CMS-10569 Supporting Statement B EQRS CY 2024 (10-26-2023).docx Supporting Statement B Uploaded 2024-01-19 Available
CMS-10569 Supporting Statement B EQRS CY 2024 (10-26-2023).docx Supporting Statement B Uploaded 2024-01-19 Repair queued

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2027 36 Months From Approved 11/30/2025
507,837 0 532,931
1,848,212 0 3,272,444
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network CMS-10569, CMS-10569 ,  

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 507,837 532,931 0 -25,094 0 0
Annual Time Burden (Hours) 1,848,212 3,272,444 0 -1,424,232 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No