Information Collection Request

Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

ICR 202410-0938-008 · OMB 0938-1171 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10432 IPFQR_PIX Survey Form and Instruction Modified Repair queued
Form CMS-10432 IPFQR Program Data Entry Screen Shots Form and Instruction Modified Available
Form CMS-10432 Inpatient Psychiatric Facility Quality Reporting Program Form Modified Repair queued
CMS-10432.Supporting Statement Part A (CMS-1806-F) - FINAL-2-25-25.docx Supporting Statement A Uploaded 2025-02-27 Repair queued
CMS-10432.Supporting Statement Part A (CMS-1806-F).docx Supporting Statement A Uploaded 2024-10-04 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
202349 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction ModifiedIPFQR_PIX Survey
202349 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction ModifiedIPFQR Program Data Entry Screen Shots
202349 Inpatient Psychiatric Facility Quality Reporting Program Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/29/2028 36 Months From Approved 01/31/2027
12,838,224 0 12,838,224
2,712,265 0 2,712,265
0 0 0





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1
table that charts list of burden
IC Title Form No. Form Name
Inpatient Psychiatric Facility Quality Reporting Program CMS-10432, CMS-10432 ,  

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 12,838,224 12,838,224 0 0 0 0
Annual Time Burden (Hours) 2,712,265 2,712,265 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No