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Hospital Quality Reporting User Language Card Sort (CMS-10871)
Generic Clearance for the Center for Clinical Standards and Quality IT Product and Support Teams (CMS-10706)
OMB: 0938-1397
IC ID: 267563
OMB.report
HHS/CMS
OMB 0938-1397
ICR 202405-0938-010
IC 267563
( )
Documents and Forms
Document Name
Document Type
Form CMS-10871
Hospital Quality Reporting User Language Card Sort (CMS-10871)
Form and Instruction
CMS-10871 HQR User Language Card Sort
CMS-10871 CMS Generic Clearance for HQR User Language Card Sort.docx
Form and Instruction
CMS-10871 HQR User Language Card Sort
CMS-10871 CMS Generic Clearance for HQR User Language Card Sort.docx
Form and Instruction
CMS-10871 CMS Generic Clearance for HQR User Language Card Sort.docx
Supporting Statement
IC Document
CMS-10871 CMS Generic Clearance for HQR User Language Card Sort.docx
Supporting Statement
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Hospital Quality Reporting User Language Card Sort (CMS-10871)
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-10871
HQR User Language Card Sort
CMS-10871 CMS Generic Clearance for HQR User Language Card Sort.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
75
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
75
0
75
0
0
0
Annual IC Time Burden (Hours)
18
0
18
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement
CMS-10871 CMS Generic Clearance for HQR User Language Card Sort.docx
05/09/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.