Information Collection

Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System

IC 211726 under ICR 202406-0915-002 · OMB 0915-0387.

Documents and Forms

Document Name Document Type
Form 1 Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Form and Instruction
1 PIMS Measures - SHCPQI PIMS Measures - FORHP - SHCPQI - Revision - 06072024.docx Form and Instruction
1 PIMS Measures - SHCPQI PIMS Measures - FORHP - SHCPQI - Revision - 06072024.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	PIMS Measures - SHCPQI	PIMS Measures - FORHP - SHCPQI - Revision - 06072024.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21	Number of Respondents for Small Entity: 21

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	21	-11	32
Annual IC Time Burden (Hours)	284	28	256
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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