Information Collection Request

Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

ICR 202505-0938-004 · OMB 0938-1171 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10432 Data Accuracy and Completeness Acknowledgement (DACA) Form and Instruction Modified Available
Form CMS-10432 IPFQR_PIX Survey Form and Instruction Modified Available
Form CMS-10432 IPFQR Program Data Entry Screen Shots Form and Instruction Modified Available
Form CMS-10432 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction Modified Repair queued
CMS-10432 FY 2026 NPRM_CMS-1831P_Supporting Statement Part A_.docx Supporting Statement A Uploaded 2025-05-21 Available
CMS-10432 FY 2026 NPRM_CMS-1831P_Supporting Statement Part A_.docx Supporting Statement A Uploaded 2025-05-21 Repair queued
FY26-IPFQR-PRA-Crosswalk and Technical Corrections_5.14.2025.docx Supplementary Document Uploaded 2025-05-19 Available
FY26-IPFQR-PRA-Crosswalk and Technical Corrections_5.14.2025.docx Supplementary Document Uploaded 2025-05-19 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
202349 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction ModifiedData Accuracy and Completeness Acknowledgement (DACA)
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 and Instruction Modified

ICR Details

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





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



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  No