Information Collection Request

HSQ-110 Acquisition, Protection, and Disclosure of Quality Improvement Organization (QIO) Information and Supporting Regulations (CMS-R-70)

ICR 202511-0938-016 · OMB 0938-0426 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-R-70-Supporting Statement_8-4-2025 Clean.docx Supporting Statement A Uploaded 2025-11-25 Available

IC Document Collections

ICR Details

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  Requested Previously Approved
36 Months From Approved
53,850 0
521,599 0
0 0





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table that charts list of burden
IC Title Form No. Form Name
ICR Req's in HSQ-110, Acquisition, Protection and Disclosure of PRO Information and Supporting Regulations in 42 CFR 476.104, 476.105, 476.116, 476.134

table that charts list of burden
  Total Request 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 53,850 0 0 0 0 53,850
Annual Time Burden (Hours) 521,599 0 0 117,391 0 404,208
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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