OMB control number

Consumer Research on Public Reporting of Hospital Quality Measures (CMS-10360)

OMB 0938-1143 · HHS/CMS.

OMB 0938-1143

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10360 Screener_Informal Family Caregivers	Form
Form CMS-10360 Screener_Healthcare Patient Consumers	Form
Form CMS-10360 Consent Form	Form
Form CMS-10360 HC Formative Testing Handout 3_	Form
Form CMS-10360 HC Formative Testing Handout 2	Form
Form CMS-10360 HC Formative Testing Handout	Form
Form CMS-10360 HC Formative Focus Group Mod Guide	Form
Form CMS-10360 Consent Form	Form
Form CMS-10360 Intensive Interview Guide_Physicians_ HAC_HAI_ED	Form
Form CMS-10360 HAI_HAC_MockUps	Form
Form CMS-10360 ED throughput	Form
Form CMS-10360 Screener_Physicians	Form
Form CMS-10360 ED throughput	Form
Form CMS-10360 HAI_HAC_MockUps	Form
Form CMS-10360 Screener_Informal Family Caregivers	Form and Instruction
Form CMS-10360 Consent Form	Form and Instruction
Form CMS-10360 Screener_Healthcare Patient Consumers	Form and Instruction
CMS-10360.REVISED - Supporting Statement Part B.pdf	Supporting Statement B
CMS-10360.REVISED Supporting Statement Part A_080511.pdf	Supporting Statement A
Consumer Research on Public Reporting of Hospital Quality Measures (IC's 3 and 4)	Form
Consumer Research on Public Reporting of Hospital Quality Measures (IC's 3 and 4)	Form
Consumer Research on Public Reporting of Hospital Quality Measures (IC's 3 and 4)	Form
Consumer Research on Public Reporting of Hospital Quality Measures (IC's 3 and 4)	Form
Consumer Research on Public Reporting of Hospital Quality Measures (IC's 3 and 4)	Form
Consumer Research on Public Reporting of Hospital Quality Measures (IC's 3 and 4)	Form
Consumer Research on Public Reporting of Hospital Quality Measures (IC's 3 and 4)	Form
Interviews	Form
Interviews	Form
Interviews	Form
Interviews	Form
Interviews	Form
Inital Screening Round 2 (Cognitive Interviews)	Form
Inital Screening Round 2 (Cognitive Interviews)	Form
Inital Screening Round 2 (Cognitive Interviews)	Form and Instruction
Inital Screening Round 2 (Cognitive Interviews)	Instruction
Inital Screening Round 2 (Cognitive Interviews)	Form and Instruction
Inital Screening Round 2 (Cognitive Interviews)	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201107-0938-003	New collection (Request for a new OMB Control Number)	2011-07-07		Approved with change
201103-0938-005	New collection (Request for a new OMB Control Number)	2011-03-18		Withdrawn