Information Collection Request

Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

ICR 202405-0938-001 · OMB 0938-1171 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10432 • IPFQR Program Data Entry Screen Shots (includes NOP, DACA, and Vendor Authorization Forms) Form and Instruction Modified Available
Form CMS-10432 PIX Survey Form Modified Available
Form CMS-10432 Inpatient Psychiatric Facility Quality Reporting Program Form Modified Repair queued
CMS-10432.SupportingStatementPartA (CMS-1806-P rule).docx Supporting Statement A Uploaded 2024-05-02 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
202349 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction Modified• IPFQR Program Data Entry Screen Shots (includes NOP, DACA, and Vendor Authorization Forms)
202349 Inpatient Psychiatric Facility Quality Reporting Program Form ModifiedPIX Survey
202349 Inpatient Psychiatric Facility Quality Reporting Program Form Modified

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2027 36 Months From Approved 01/31/2027
12,838,224 0 12,838,224
2,712,265 0 2,712,265
0 0 0





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1
table that charts list of burden
IC Title Form No. Form Name
Inpatient Psychiatric Facility Quality Reporting Program CMS-10432, CMS-10432 ,  



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