Information Collection Request

Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb) (CMS-10569)

ICR 202512-0938-001 · OMB 0938-1289 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10569 EQRS Global App Form and Instruction Modified Available
Form CMS-10569 Letter to Facilities - data collection Form and Instruction Modified Available
Form CMS-10569 : End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network Form and Instruction Modified Missing upstream
CMS-10569 Supporting Statement B EQRS CY 2026 (11-13-2025).docx Supporting Statement B Uploaded 2025-12-01 Available
CMS-10569 Supporting Statement B EQRS CY 2026 (11-13-2025).docx Supporting Statement B Uploaded 2025-12-01 Missing upstream
CMS-10569 Supporting Statement A EQRS CY 2026_12-1-25.docx Supporting Statement A Uploaded 2025-12-01 Available
CMS-10569 Supporting Statement A EQRS CY 2026_12-1-25.docx Supporting Statement A Uploaded 2025-12-01 Repair queued

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2029 36 Months From Approved 01/31/2027
513,475 0 511,957
863,173 0 967,280
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network CMS-10569, CMS-10569 ,  

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 513,475 511,957 0 1,518 0 0
Annual Time Burden (Hours) 863,173 967,280 0 -104,107 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No