Information Collection

Inpatient Psychiatric Facility Quality Reporting Program

IC 202349 under ICR 202410-0938-008 · OMB 0938-1171.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1171 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10432 Inpatient Psychiatric Facility Quality Reporting Program	Form
Form CMS-10432 IPFQR Program Data Entry Screen Shots Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction
Form CMS-10432 IPFQR_PIX Survey Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction
CMS-10432 PIX Survey IPFQR_PIX Survey.pdf	Form
CMS-10432 IPFQR Program Data Entry Screen Shots IPFQR Program Data Entry Screen Shots.pdf	Form and Instruction
CMS-10432 IPFQR Program Data Entry Screen Shots IPFQR Program Data Entry Screen Shots.pdf	Form and Instruction
CMS-10432 IPFQR_PIX Survey IPFQR_PIX Survey (final-2-25-25).pdf	Form and Instruction

IC Title:

Inpatient Psychiatric Facility Quality Reporting Program

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10432				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10432				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Medicare Beneficiary Database (09-70-0536)

FR Citation: 71 FR 70396

Number of Respondents: 1,596

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: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	12,838,224	12,838,224
Annual IC Time Burden (Hours)	2,712,265	2,712,265
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].