Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System

Small Health Care Provider Quality Improvement Program Performance Improvement Measurement System (PIMS)

Documents and Forms

Document Name Document Type
Form 1 Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Form and Instruction
FORHP 0906-0102 - SHCPQI Program Measures (redline) 062625.docx Other-Redline
1 PIMS Measures - SHCPQI FORHP 0906-0102 - SHCPQI Program Measures (clean) 062625.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	PIMS Measures - SHCPQI	FORHP 0906-0102 - SHCPQI Program Measures (clean) 062625.docx		Yes	Yes	Fillable Fileable
Other-Redline			FORHP 0906-0102 - SHCPQI Program Measures (redline) 062625.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21	Number of Respondents for Small Entity: 21

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	21	21
Annual IC Time Burden (Hours)	284	284
Annual IC Cost Burden (Dollars)	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.