OMB control number
National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) (CMS-10639)
OMB 0938-1340 · HHS/CMS.
OMB 0938-1340
For the PY 2028 validation, CMS is continuing to use its previously finalized policy to select 300 facilities to participate in an NHSN Dialysis Event validation by submitting a total of 20 patient records across any two quarters of data reported in CY 2026.
The latest form for National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) (CMS-10639) expires 2029-02-28 and is listed under ICR 202601-0938-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10639 Request Letter to Facilities - List | Form and Instruction |
| Form CMS-10639 Request Letter to Facilities Records | Form and Instruction |
| CMS-10639 Supporting Statement A NHSN CY 2027 (06-23-2026).docx | Supporting Statement A |
| CMS-10639 Supporting Statement B NHSN CY 2027 (06-23-2026)).docx | Supporting Statement B |
 National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) |
Form and Instruction |
| National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) |
Form and Instruction |