Information Collection

Rural Emergency Hospital Quality Reporting (REHQR) Program

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10870				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 %

table that charts list of burden
	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

table that charts IC Documents
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.

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