Rural Emergency Hospital Quality Reporting (REHQR) Program

Rural Emergency Hospital Quality Reporting (REHQR) (CMS-10870)

Documents and Forms

Document Name Document Type
Form CMS-10870 Rural Emergency Hospital Quality Reporting (REHQR) Program Form and Instruction
CMS-10870 Centers for Medicare & Medicaid Services (CMS) Quality P Extraordinary Circumstances Exceptions Request Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Rural Emergency Hospital Quality Reporting (REHQR) Program	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10870	Centers for Medicare & Medicaid Services (CMS) Quality Program Extraordinary Circumstances Exceptions (ECE) Request Form	Extraordinary Circumstances Exceptions Request Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 746	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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	187,992	0	187,992
Annual IC Time Burden (Hours)	6,262	-2,839	9,101
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.