Information Collection

Quality Measures and Procedures for Hospital Reporting of Quality Data

IC 204350 under ICR 202604-0938-027 · OMB 0938-1022.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form CMS-10210
Data Accuracy and Completeness Form Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
Hospital VPB Review and Corrections Form Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
Extraordinary Circumstances Form Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
Hospital Compare Request Form for Withholding/Footnoting Data for Public Reporting Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
IQR Notice of Participation Form Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
IQR Reconsideration Request Form Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
Validation Review for Reconsideration Request Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
VBP Appeal Request Form Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
HVBP CMS Independent Review Form Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
Validation Educational Review Form Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
Maternal Morbidity Structural Measure Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
Population and Sampling Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
Hospital Inpatient Quality Reporting Program Denominator Declaration Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
THA/TKA Patient-Reported Outcome-based Performance Measure Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
Form CMS-10210
Age Friendly Structural Measure Quality Measures and Procedures for Hospital Reporting of Quality Data
Form and Instruction
CMS-10210 Data Accuracy and Completeness Form
02. Hospital Quality Reporting Data Accuracy and Completeness Acknowledgement (DACA).pdf
Form and Instruction
CMS-10210 Hospital VPB Review and Corrections Form
13. Hospital Value-Based Purchasing (VBP) Program Review and Corrections Request Form.pdf
Form and Instruction
CMS-10210 Extraordinary Circumstances Form
06. CMS Quality Program ECE Request Form_CY 2027.pdf
Form and Instruction
CMS-10210 Hospital Compare Request Form for Withholding/Footnoting
03. Care Compare Withholding Footnoting Request Form_CY 2027.pdf
Form and Instruction
CMS-10210 IQR Notice of Participation Form
01. Hospital Inpatient Quality Reporting Notice of Participation.pdf
Form and Instruction
CMS-10210 IQR Reconsideration Request Form
04. CMS Quality Reporting Program APU Reconsideration Request Form.pdf
Form and Instruction
CMS-10210 Validation Review for Reconsideration Request
05. CMS Hospital IQR Program Validation Review for Reconsideration Request Form.pdf
Form and Instruction
CMS-10210 VBP Appeal Request Form
14. Hospital Value-Based Purchasing (VBP) Program Appeal Request Form.pdf
Form and Instruction
CMS-10210 HVBP CMS Independent Review Form
15. Hospital Value-Based Purchasing (VBP) Program Independent CMS Review Request Form.pdf
Form and Instruction
CMS-10210 Validation Educational Review Form
09. HQR_Val Ed Review Form.pdf
Form and Instruction
CMS-10210 Maternal Morbidity Structural Measure
07. Maternal Morbidity Structural Measure.pdf
Form and Instruction
CMS-10210 Population and Sampling
08. Population and Sampling.pdf
Form and Instruction
CMS-10210 Hospital Inpatient Quality Reporting Program Denominator
10. Denominator Declaration.pdf
Form and Instruction
CMS-10210 THA/TKA Patient-Reported Outcome-based Performance Measu
11. THA_TKA PRO-PM.pdf
Form and Instruction
CMS-10210 Age Friendly Structural Measure
12. Age Friendly Structural Measure.pdf
Form and Instruction
00. Summary of HQR Information Collection Forms - FY2027 IPPS Final Rule_508 (1).pdf
Summary of Updates on Hospital Quality Reporting Information Collection Forms
IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable
Form and Instruction CMS-10210 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 18,200 0 200 0 0 18,000
Annual IC Time Burden (Hours) 1,354,664 0 3,032 0 0 1,351,632
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Summary of Updates on Hospital Quality Reporting Information Collection Forms 05/20/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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