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HOPE and HUV Timepoint
Hospice Quality Reporting Program (CMS-10390)
OMB: 0938-1153
IC ID: 269622
OMB.report
HHS/CMS
OMB 0938-1153
ICR 202409-0938-004
IC 269622
( )
Documents and Forms
Document Name
Document Type
Form CMS-10390
HOPE and HUV Timepoint
Form
CMS-10390 Hospice Outcome and Patient Evaluation
HOPE v1.00_All Item_508c.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HOPE and HUV Timepoint
Agency IC Tracking Number:
10390
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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-10390
Hospice Outcome and Patient Evaluation
HOPE v1.00_All Item_508c.pdf
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:
5,640
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:
0 %
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
2,763,600
0
0
2,763,600
0
0
Annual IC Time Burden (Hours)
2,487,465
0
0
2,487,465
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.
