Information Collection Request

Quality Measures and Administrative Procedures for the Hospital-Acquired Condition Reduction Program (CMS-10668)

ICR 202509-0938-011 · OMB 0938-1352 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10668 CMS Hospital-Acquired Condition (HAC) Reduction Program Validation Review for Reconsideration Request Form and Instruction Unchanged Available
Form CMS-10668 Measure Exception Form for Healthcare-Associated Infection (HAI) Data Form and Instruction Unchanged Available
Form CMS-10668 MRSA Validation Template Form and Instruction Unchanged Available
Form CMS-10668 CLABSI Validation Template Form and Instruction Unchanged Available
Form CMS-10668 CDI Validation Template Form and Instruction Unchanged Available
Form CMS-10668 Cauti Validation Template Form and Instruction Unchanged Available
Form CMS-10668 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation Form and Instruction Unchanged Repair queued
CMS-10668 HACRP FY2026 Supporting Statement B_9-925.docx Supporting Statement B Uploaded 2025-09-10 Available
CMS-10668 HACRP FY2026 Supporting Statement B_9-925.docx Supporting Statement B Uploaded 2025-09-10 Repair queued
CMS-10668 HACRP FY2026 Supporting Statement A 9-9-25.docx Supporting Statement A Uploaded 2025-09-10 Available
CMS-10668 HACRP FY2026 Supporting Statement A 9-9-25.docx Supporting Statement A Uploaded 2025-09-10 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
231482 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation Form and Instruction UnchangedCMS Hospital-Acquired Condition (HAC) Reduction Program Validation Review for Reconsideration Request
231482 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation Form and Instruction UnchangedMeasure Exception Form for Healthcare-Associated Infection (HAI) Data
231482 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation Form and Instruction UnchangedMRSA Validation Template
231482 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation Form and Instruction UnchangedCLABSI Validation Template
231482 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation Form and Instruction UnchangedCDI Validation Template
231482 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation Form and Instruction UnchangedCauti Validation Template
231482 Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2029 36 Months From Approved 11/30/2027
640 0 640
28,840 0 28,840
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Hospital-Acquired Condition Reduction Program-NHSN HAI Measures Validation CMS-10668, CMS-10668, CMS-10668, CMS-10668, CMS-10668, CMS-10668 ,   ,   ,   ,   ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 640 640 0 0 0 0
Annual Time Burden (Hours) 28,840 28,840 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No