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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 211726 under ICR 202506-0906-003 · OMB 0906-0102.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Other-Redline
Other-Redline
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System
 
No Modified
 
Required to Obtain or Retain Benefits
 

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

Health Health Care Services

 

21 21
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 21 0 0 0 0 21
Annual IC Time Burden (Hours) 284 0 0 0 0 284
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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