Information Collection Request

Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

ICR 202607-0938-019 · OMB 0938-1171 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10432 Psychiatric Inpatient Experience (PIX) Survey Form and Instruction Modified Available
Form CMS-10432 IPFQR Data Entry Screen Shots Form and Instruction Modified Available
Form CMS-10432 Data Accuracy and Completeness Acknowledgement (DACA) Form and Instruction Modified Available
CMS-10432 IPFQR FY 2027 FR Supporting Statement Part A_Final rule_clean.docx Supporting Statement A Uploaded 2026-09-15 Available
CMS-10432_9_IPFQR_ Summary of IPFQR Information Collection Forms - FY 2027 IPFQR Final Rule_CY 2027_20260818_508.pdf Supplementary Document Uploaded 2026-09-15 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
202349 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction ModifiedPsychiatric Inpatient Experience (PIX) Survey
202349 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction ModifiedIPFQR Data Entry Screen Shots
202349 Inpatient Psychiatric Facility Quality Reporting Program Form and Instruction ModifiedData Accuracy and Completeness Acknowledgement (DACA)

ICR Details

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table that charts list comparision
  Requested Previously Approved
36 Months From Approved 02/29/2028
8,952,336 10,820,880
2,179,121 2,645,051
0 0





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table that charts list of burden
IC Title Form No. Form Name
Inpatient Psychiatric Facility Quality Reporting Program CMS-10432, CMS-10432, CMS-10432 ,   ,  

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 8,952,336 10,820,880 0 -1,868,544 0 0
Annual Time Burden (Hours) 2,179,121 2,645,051 0 -465,930 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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