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HQIC Hospital Survey
Evaluation of the CMS Network of Quality Improvement and Innovation Contractors Program (NQIIC) (CMS-10769)
OMB: 0938-1424
IC ID: 248181
OMB.report
HHS/CMS
OMB 0938-1424
ICR 202401-0938-008
IC 248181
( )
Documents and Forms
Document Name
Document Type
Form CMS-10769
HQIC Hospital Survey
Form and Instruction
CMS-10769 HQIIC Hospital Survey
CMS-10769_App_B_HQIC_Hospital_Survey_Instrument_062922_508c.docx
Form and Instruction
CMS-10769_Crosswalk_Hospital_Survey_Questions_(HQIC)_062922_508c.docx
Crosswalk - Hospital Survey
IC Document
CMS-10769_App_D.3_Survey_Pre-Notification_Hosp_Communication_10262022_508c.docx
Pre-noitification letter for Hospital Survey
IC Document
CMS-10769_App_D.4_Hospital_follow-up_VM_and_email_10262022_508c.docx
Hospital Follow-up email
IC Document
Information Collection (IC) Details
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