Information Collection

Hospital Outpatient Quality Reporting

IC 217995 under ICR 202508-0938-010 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10250 Hospital Outpatient Quality Reporting	Form and Instruction
Hospital OQR Specifications Manual, v19.pdf.pdf	Instruction
CMS-10250 Web Based Data Collection Tool HQROQRPRAStatement_Screenshots.pdf	Form and Instruction
CMS-10250.OQR_With CMS-10250.OQR_Withdraw Form CMS-10250.OQR_Withdraw Form.docx	Form and Instruction
CMS-10250 CMS-10250.HOQR ProgramValidationReconForm CMS-10250.HOQR ProgramValidationReconForm.pdf	Form and Instruction
CMS-10250 CMS.10250.Extraordinary Circumstances Exemption Request HQR_ECE_Req_Form_CY_2025.pdf	Form and Instruction
CMS-10250 CMS Quality Reporting Program APU Reconsideration Reques CMS Quality Reporting Program APU Reconsideration Request Form.pdf	Form and Instruction
SmryHQRInfoClctnForms_CY2026OPPSFinalRule.pdf Summary of Updates	IC Document

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10250	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10250.OQR_Withdraw Form	Yes	Yes	Fillable Fileable
Instruction		Yes	No	Printable Only
Form and Instruction	CMS-10250	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10250	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10250	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Medicare Beneficiary Database (MBD)

FR Citation: 83 FR 6591

Number of Respondents: 3,200

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 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40,960,000	0	40,960,000
Annual IC Time Burden (Hours)	9,882,620	-5,302,377	15,184,997
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Summary of Updates		08/19/2025

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

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