Information Collection Request

Small Health Care Provider Quality Improvement Program Performance Improvement Measurement System (PIMS)

ICR 202408-0906-004 · OMB 0906-0102 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Form and Instruction Modified Available
Supporting Statement A - FORHP - SHCPQI - Revision - 06072024.docx Supporting Statement A Uploaded 2024-06-21 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
211726 Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2027 36 Months From Approved
21 0 32
284 0 256
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System 1 PIMS Measures - SHCPQI

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 21 32 0 -11 0 0
Annual Time Burden (Hours) 284 256 0 28 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No