Information Collection

§495.24(e) Objectives/Measures (hospitals/CAHs)

IC 216082 under ICR 202507-0938-011 · OMB 0938-1278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1278 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10552 ?495.24(e) Objectives/Measures (hospitals/CAHs)	Form and Instruction
Form CMS-10552 Attestation screen shots §495.24(e) Objectives/Measures (hospitals/CAHs)	Form and Instruction
Form cms-10552 Medicare Promoting Interoperability Program Hardship Exception Application §495.24(e) Objectives/Measures (hospitals/CAHs)	Form and Instruction
HQR_User_Guide_(11-13-2023)_508.pdf	Instruction
HQR_User_Guide_(11-13-2023)_508.pdf	Instruction
CMS-10552 Attestation screen shots NG Attestation screen_(06-05-2024)_508_.pdf	Form and Instruction
CMS-10552 Attestation screen shots NG Attestation screen_(06-05-2024)_508_.pdf	Form and Instruction
cms-10552 Medicare Promoting Interoperability Program Hardship Exc hospital-hardship-form-pra-2025.pdf	Form and Instruction
cms-10552 Medicare Promoting Interoperability Program Hardship Exc hospital-hardship-form-pra-2025.pdf	Form and Instruction

IC Title:

§495.24(e) Objectives/Measures (hospitals/CAHs)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 495.24

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10552	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Form and Instruction	cms-10552	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,550

Number of Respondents for Small Entity: 2,331

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
	Requested	Previously Approved
Annual Number of Responses for this IC	4,550	4,550
Annual IC Time Burden (Hours)	30,151	30,151
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].