Information Collection

Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised)

IC 267565 under ICR 202405-0938-010 · OMB 0938-1397.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10800 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised)	Form and Instruction
CMS-10800 Single Ease Question for User Insights on Hospital Quali CMS-10800 Generic Clearance_07192021_HQR_Touchpoints_REVISEDOct2023.docx	Form and Instruction
CMS-10800 Single Ease Question for User Insights on Hospital Quali CMS-10800 Generic Clearance_07192021_HQR_Touchpoints_REVISEDOct2023.docx	Form and Instruction
CMS-10800 Generic Clearance_07192021_HQR_Touchpoints_REVISEDOct2023.docx Supporting Statement	IC Document
CMS-10800 Generic Clearance_07192021_HQR_Touchpoints_REVISEDOct2023.docx Supporting Statement	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10800	Single Ease Question for User Insights on Hospital Quality Reporting	CMS-10800 Generic Clearance_07192021_HQR_Touchpoints_REVISEDOct2023.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 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	CMS-10800 Generic Clearance_07192021_HQR_Touchpoints_REVISEDOct2023.docx	05/09/2024

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