Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised)

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

Documents and Forms

Document Name Document Type
Form CMS-10817 Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) Form and Instruction
CMS-10817 HQR User Research Participation Survey Revised CMS-10817 Generic Clearance for HQR User Research Participation Survey.docx Form and Instruction
CMS-10817 HQR User Research Participation Survey Revised CMS-10817 Generic Clearance for HQR User Research Participation Survey.docx Form and Instruction
Revised CMS-10817 Generic Clearance for HQR User Research Participation Survey.docx Supporting Statement IC Document
Revised CMS-10817 Generic Clearance for HQR User Research Participation Survey.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10817	HQR User Research Participation Survey	Revised CMS-10817 Generic Clearance for HQR User Research Participation Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	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
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Revised CMS-10817 Generic Clearance for HQR User Research Participation Survey.docx	05/09/2024

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