Information Collection Request

Generic Clearance for the Center for Clinical Standards and Quality IT Product and Support Teams (CMS-10706)

ICR 202405-0938-010 · OMB 0938-1397 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10979 Customer AI Trust Survey Form and Instruction New Repair queued
Form CMS-10967 Site-Intercept Survey Form and Instruction New Repair queued
Form CMS-10965 QIO Participant Age-Friendly Survey Form and Instruction New Repair queued
Form CMS-10965 Age Friendly Survey Scoring Form and Instruction New Repair queued
Form CMS-10965 Age Friendly Readiness Assessment Form and Instruction New Repair queued
Form CMS-10964 QualityNet Files Page Intercept Survey Form and Instruction New Repair queued
Form CMS-10951 iQIES Data Request form Form and Instruction New Repair queued
Form CMS-10936 Welcome Packet Form and Instruction New Repair queued
Form CMS-10936 DAC Follow-up Communication Templates Form and Instruction New Repair queued
Form CMS-10936 User Feedback Recruitment Flyer Form and Instruction New Repair queued
Form CMS-10936 Provider Recruitment Flyer Form and Instruction New Repair queued
Form CMS-10936 Webpage Patient and Caregiver User Feedback Session Interest Form Form and Instruction New Repair queued
Form CMS-10936 Webpage Provider User Feedback Session Interest Form Form and Instruction New Repair queued
Form CMS-10940 EPCS Webinar Survey Form and Instruction New Repair queued
Form CMS-10939 EPCS Education & Outreach (E&O) Document Survey Form and Instruction New Repair queued
Form CMS-10938 CCSQ Service Center Customer Experience Incident Survey Form and Instruction New Repair queued
Form CMS-10937 QSEP Help Desk Form Form and Instruction New Repair queued
Form CMS-10929 MADiE Survey Form and Instruction New Repair queued
Form CMS-10928 Hospital Quality Reporting Communications Survey Form and Instruction New Repair queued
Form CMS-10927 CQP Ideal Portal Form and Instruction New Repair queued
Form CMS-10919 13th SOW QIN-QIO Focused QIO Service (FQS) Experience Survey Form and Instruction New Repair queued
Form CMS-10919 13th SOW Rapid Cycle Experience Survey Form and Instruction New Repair queued
Form CMS-10926 Qualtrics Survey - QEM Form New Repair queued
Form CMS-10922 Support Central Post Webinar Survey Form and Instruction New Repair queued
Form CMS-10920 EQRS Idea Portal Screen shots Form and Instruction New Repair queued
Form CMS-10838 Survey Instrument - Submissions Intercept Form and Instruction New Repair queued
Form CMS-10833 Service Center Customer Experience Survey Form and Instruction New Repair queued
Form CMS-10907 Transplant Center Data Exchange Capabilities Survey Form and Instruction New Repair queued
Form CMS-10904 HQR Idea Portal Form Form and Instruction New Repair queued
Form CMS-10896 CCSQ Support Central Live Chat Virtual Agent Survey Form and Instruction New Available
Form CMS-10896 CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) Form and Instruction New Available
Form CMS-10886 CCSQ Support Central Knowledge Research Survey Form and Instruction New Available
Form CMS-10886 CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) Form and Instruction New Repair queued
Form CMS-10800 Single Ease Question for User Insights on Hospital Quality Reporting Form and Instruction New Available
Form CMS-10800 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised) Form and Instruction New Repair queued
Form CMS-10871 HQR User Language Card Sort Form and Instruction New Available
Form CMS-10871 Hospital Quality Reporting User Language Card Sort (CMS-10871) Form and Instruction New Repair queued
Form CMS-10817 HQR User Research Participation Survey Form and Instruction New Available
Form CMS-10817 Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) Form and Instruction New Repair queued
Form CMS-10838 Submissions Intercept Survey Form and Instruction New Available
Form CMS-10838 QPP Submissions Intercept Survey (CMS-10838) Form and Instruction New Repair queued
Form CMS-10832 Support Central screen shots Form and Instruction New Available
Form CMS-10832 Chat/CCSQ Support Central – Basic information questions (CMS-10832) Form and Instruction New Repair queued
Form CMS-10833 QPP Customer Effort Questionnaire: 2020 Online Survey (Draft 1) Form and Instruction New Available
Form CMS-10833 QualityNet Help Desk Customer Feedback Survey Form and Instruction New Available
Form CMS-10833 QualityNet-EQRS Help Desk Customer Feedback Survey Form and Instruction New Available
Form CMS-10833 Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction New Repair queued
Form CMS-10818 Track Existing Ticket Form and Instruction New Available
Form CMS-10818 Live Chat Form and Instruction New Available
Form CMS-10818 Create A Ticket Form and Instruction New Available
Form CMS-10818 Call Scheduling Form and Instruction New Available
Form CMS-10818 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction New Repair queued
Form CMS-10810 Idea Portal Form and Instruction New Available
Form CMS-10810 Internet Quality Improvement and Evaluation System (IQIES) Idea Portal (CMS-10810) Form and Instruction New Repair queued
Form CMS-10808 iQIES HCD User Research Form Form and Instruction New Available
Form CMS-10808 Internet Quality Improvement and Evaluation System (iQIES) HCD User Research Form (CMS-10808) Form and Instruction New Repair queued
Form CMS-10804 QPP Site Intercept Survey Form and Instruction New Available
Form CMS-10804 Quality Payment Program Site Intercept Survey (CMS-10804) Form and Instruction New Repair queued
CMS-10706 Template_CCSQ Generic Clearance_07192021_clean copy.docx Supplementary Document Uploaded 2021-07-20 Repair queued
CMS-10706_SuppStmt_Part B_final 2-22-24 .docx Supporting Statement B Uploaded 2024-05-09 Repair queued
CMS-10706_SuppStmt_Part A_FINAL-2024-02-22.docx Supporting Statement A Uploaded 2024-05-09 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
281626 CCSQ Service Center AI and Trust Research Survey (CMS-10979) Form and Instruction NewCustomer AI Trust Survey
281228 CCSQ Support Central Site-Intercept Survey (CMS-10967) Form and Instruction NewSite-Intercept Survey
280617 CMS Age-Friendly Readiness Assessment (CMS-10965) Form and Instruction NewQIO Participant Age-Friendly Survey
280617 CMS Age-Friendly Readiness Assessment (CMS-10965) Form and Instruction NewAge Friendly Survey Scoring
280617 CMS Age-Friendly Readiness Assessment (CMS-10965) Form and Instruction NewAge Friendly Readiness Assessment
280120 QualityNet Files Page Intercept Survey (CMS-10964) Form and Instruction NewQualityNet Files Page Intercept Survey
279634 iQIES Data Request Portal (CMS-10951) Form and Instruction NewiQIES Data Request form
278032 Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction NewWelcome Packet
278032 Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction NewDAC Follow-up Communication Templates
278032 Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction NewUser Feedback Recruitment Flyer
278032 Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction NewProvider Recruitment Flyer
278032 Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction NewWebpage Patient and Caregiver User Feedback Session Interest Form
278032 Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction NewWebpage Provider User Feedback Session Interest Form
277761 Electronic Prescribing of Controlled Substances (EPCS) Webinar Survey (CMS-10940) Form and Instruction NewEPCS Webinar Survey
277721 Electronic Prescribing of Controlled Substances (EPCS) - Education & Outreach (E&O) Document Survey (CMS-10939) Form and Instruction NewEPCS Education & Outreach (E&O) Document Survey
277071 CCSQ Service Center Customer Experience Incident Survey (CMS-10938) Form and Instruction NewCCSQ Service Center Customer Experience Incident Survey
277070 Contact Quality, Safety and Education Portal (QSEP) Help Desk (CMS-10937) Form and Instruction NewQSEP Help Desk Form
277069 System Usability Scale Survey for MADiE (CMS-10929) Form and Instruction NewMADiE Survey
276374 Hospital Quality Reporting Communications Survey (CMS-10928) Form and Instruction NewHospital Quality Reporting Communications Survey
275827 Idea Portal for User Insights on CMS Quality Improvement Organization Platform (CQP) (CMS-10927) Form and Instruction NewCQP Ideal Portal
275826 13th Statement of Work (SoW) Quality Improvement Network-Quality Improvement Organization (QIN-QIO) and American Indian/Alaska Native (AIAN-QIO) Provider Experience Encounter Survey (CMS-10919) Form and Instruction New13th SOW QIN-QIO Focused QIO Service (FQS) Experience Survey
275826 13th Statement of Work (SoW) Quality Improvement Network-Quality Improvement Organization (QIN-QIO) and American Indian/Alaska Native (AIAN-QIO) Provider Experience Encounter Survey (CMS-10919) Form and Instruction New13th SOW Rapid Cycle Experience Survey
275429 iQIES Post-Launch Sentiment Survey (CMS-10926) Instruction New
275429 iQIES Post-Launch Sentiment Survey (CMS-10926) Form NewQualtrics Survey - QEM
275354 CCSQ Support Central Post-Webinar Customer Feedback Survey (CMS-10922) Form and Instruction NewSupport Central Post Webinar Survey
273691 End Stage Renal Disease Quality Reporting System EQRS (EQRS) Idea Portal. (CMS-10920 Form and Instruction NewEQRS Idea Portal Screen shots
272504 QPP Submissions Intercept Survey (CMS-10838) Form and Instruction NewSurvey Instrument - Submissions Intercept
271820 Customer Experience Surveys (CMS-10833 revised) Form and Instruction NewService Center Customer Experience Survey
270052 Transplant Center Data Exchange Capabilities Survey (CMS-10907) Form and Instruction NewTransplant Center Data Exchange Capabilities Survey
269685 Idea Portal for User Insights on Hospital Quality Reporting (CMS-10904) Form and Instruction NewHQR Idea Portal Form
267567 CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) Form and Instruction NewCCSQ Support Central Live Chat Virtual Agent Survey
267567 CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) Form and Instruction New
267566 CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) Form and Instruction NewCCSQ Support Central Knowledge Research Survey
267566 CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) Form and Instruction New
267565 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised) Form and Instruction NewSingle Ease Question for User Insights on Hospital Quality Reporting
267565 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised) Form and Instruction New
267563 Hospital Quality Reporting User Language Card Sort (CMS-10871) Form and Instruction NewHQR User Language Card Sort
267563 Hospital Quality Reporting User Language Card Sort (CMS-10871) Form and Instruction New
267561 Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) Form and Instruction NewHQR User Research Participation Survey
267561 Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) Form and Instruction New
267559 QPP Submissions Intercept Survey (CMS-10838) Form and Instruction NewSubmissions Intercept Survey
267559 QPP Submissions Intercept Survey (CMS-10838) Form and Instruction New
267557 Chat/CCSQ Support Central – Basic information questions (CMS-10832) Form and Instruction NewSupport Central screen shots
267557 Chat/CCSQ Support Central – Basic information questions (CMS-10832) Form and Instruction New
267555 Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction NewQPP Customer Effort Questionnaire: 2020 Online Survey (Draft 1)
267555 Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction NewQualityNet Help Desk Customer Feedback Survey
267555 Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction NewQualityNet-EQRS Help Desk Customer Feedback Survey
267555 Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction New
267554 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction NewTrack Existing Ticket
267554 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction NewLive Chat
267554 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction NewCreate A Ticket
267554 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction NewCall Scheduling
267554 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction New
267553 Internet Quality Improvement and Evaluation System (IQIES) Idea Portal (CMS-10810) Form and Instruction NewIdea Portal
267553 Internet Quality Improvement and Evaluation System (IQIES) Idea Portal (CMS-10810) Form and Instruction New
267551 Internet Quality Improvement and Evaluation System (iQIES) HCD User Research Form (CMS-10808) Form and Instruction NewiQIES HCD User Research Form
267551 Internet Quality Improvement and Evaluation System (iQIES) HCD User Research Form (CMS-10808) Form and Instruction New
267550 Quality Payment Program Site Intercept Survey (CMS-10804) Form and Instruction NewQPP Site Intercept Survey
267550 Quality Payment Program Site Intercept Survey (CMS-10804) Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2027 36 Months From Approved 07/31/2024
54,750 0 11,476
17,850 0 4,957
1,819,183 0 425,509





Reginfo record details
33
table that charts list of burden
IC Title Form No. Form Name
13th Statement of Work (SoW) Quality Improvement Network-Quality Improvement Organization (QIN-QIO) and American Indian/Alaska Native (AIAN-QIO) Provider Experience Encounter Survey (CMS-10919) CMS-10919, CMS-10919 ,  
CCSQ Service Center AI and Trust Research Survey (CMS-10979) CMS-10979
CCSQ Service Center Customer Experience Incident Survey (CMS-10938) CMS-10938
CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) CMS-10886
CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) CMS-10896
CCSQ Support Central Post-Webinar Customer Feedback Survey (CMS-10922) CMS-10922
CCSQ Support Central Site-Intercept Survey (CMS-10967) CMS-10967
CMS Age-Friendly Readiness Assessment (CMS-10965) CMS-10965, CMS-10965, CMS-10965 ,   ,  
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) CMS-10818, CMS-10818, CMS-10818, CMS-10818 ,   ,   ,  
Chat/CCSQ Support Central – Basic information questions (CMS-10832) CMS-10832
Contact Quality, Safety and Education Portal (QSEP) Help Desk (CMS-10937) CMS-10937
Customer Effort Scoring - Surveys (CMS-10833) CMS-10833, CMS-10833, CMS-10833 ,   ,  
Customer Experience Surveys (CMS-10833 revised) CMS-10833
Electronic Prescribing of Controlled Substances (EPCS) - Education & Outreach (E&O) Document Survey (CMS-10939) CMS-10939
Electronic Prescribing of Controlled Substances (EPCS) Webinar Survey (CMS-10940) CMS-10940
End Stage Renal Disease Quality Reporting System EQRS (EQRS) Idea Portal. (CMS-10920 CMS-10920
Hospital Quality Reporting Communications Survey (CMS-10928) CMS-10928
Hospital Quality Reporting User Language Card Sort (CMS-10871) CMS-10871
Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) CMS-10817
Idea Portal for User Insights on CMS Quality Improvement Organization Platform (CQP) (CMS-10927) CMS-10927
Idea Portal for User Insights on Hospital Quality Reporting (CMS-10904) CMS-10904
Internet Quality Improvement and Evaluation System (IQIES) Idea Portal (CMS-10810) CMS-10810
Internet Quality Improvement and Evaluation System (iQIES) HCD User Research Form (CMS-10808) CMS-10808
Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) CMS-10936, CMS-10936, CMS-10936, CMS-10936, CMS-10936, CMS-10936 ,   ,   ,   ,   ,  
QPP Submissions Intercept Survey (CMS-10838) CMS-10838
QPP Submissions Intercept Survey (CMS-10838) CMS-10838
Quality Payment Program Site Intercept Survey (CMS-10804) CMS-10804
QualityNet Files Page Intercept Survey (CMS-10964) CMS-10964
Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised) CMS-10800
System Usability Scale Survey for MADiE (CMS-10929) CMS-10929
Transplant Center Data Exchange Capabilities Survey (CMS-10907) CMS-10907
iQIES Data Request Portal (CMS-10951) CMS-10951
iQIES Post-Launch Sentiment Survey (CMS-10926) CMS-10926

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 54,750 11,476 0 43,274 0 0
Annual Time Burden (Hours) 17,850 4,957 0 12,893 0 0
Annual Cost Burden (Dollars) 1,819,183 425,509 0 1,393,674 0 0


Reginfo record details
  No