: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network

Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb) (CMS-10569)

Documents and Forms

Document Name Document Type
Form CMS-10569 : End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network Form and Instruction
CMS_10569- Message Introducing Contractor to All Facilities_template.docx Instruction
CMS_10569- Message Introducing Contractor to All Facilities_template.docx Instruction
CMS-10569 Letter to Facilities - data collection CMS_10569_CPM Request Letter to Facilities_template.docx Form and Instruction
CMS-10569 Letter to Facilities - data collection CMS_10569_CPM Request Letter to Facilities_template.docx Form and Instruction
CMS-10569 EQRS Global App CMS-10569 screenshots 3-30-2020.docx Form and Instruction
CMS-10569 EQRS Global App CMS-10569 screenshots 3-30-2020.docx Form and Instruction

Information Collection (IC) Details

IC Title:	: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10569	Letter to Facilities - data collection	CMS_10569_CPM Request Letter to Facilities_template.docx	Yes	Yes	Fillable Fileable
Instruction			CMS_10569- Message Introducing Contractor to All Facilities_template.docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10569	EQRS Global App	CMS-10569 screenshots 3-30-2020.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: ESRD Program Management and Medical Information System (PMMIS) published	FR Citation: 74 FR 30606

Number of Respondents: 7,833	Number of Respondents for Small Entity: 958

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	507,837	0	507,837
Annual IC Time Burden (Hours)	959,497	-888,715	1,848,212
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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