Information Collection

Rural Emergency Hospital Quality Reporting (REHQR) Program

IC 262060 under ICR 202601-0938-004 · OMB 0938-1454.

Documents and Forms

Document Name Document Type
Form CMS-10870 Centers for Medicare & Medicaid Services (CMS) Quality Program Extraordinary Circumstances Exceptions (ECE) Request Form Rural Emergency Hospital Quality Reporting (REHQR) Program Form and Instruction
CMS-10870 Centers for Medicare & Medicaid Services (CMS) Quality P _ECE_Req_Form_CY_2025.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Emergency Hospital Quality Reporting (REHQR) Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 485 Section 500

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10870	Centers for Medicare & Medicaid Services (CMS) Quality Program Extraordinary Circumstances Exceptions (ECE) Request Form	_ECE_Req_Form_CY_2025.pdf		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: 38	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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	152	-4,204	4,356
Annual IC Time Burden (Hours)	464	-8,115	8,579
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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].