National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) (CMS-10639)

OMB 0938-1340

For the PY 2021 study, CMS is proposing to select 150 facilities to participate in an NHSN Dialysis Event validation study by submitting 20 patient records covering two quarters of data reported in CY 2019.

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 2023-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10639 National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) Form and Instruction
Form CMS-10639 National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) Form and Instruction
CMS-10639 Supporting Statement A NHSN CY 2024 (10-26-2023).docx Supporting Statement A
CMS-10639 Supporting Statement A NHSN CY 2024 (10-26-2023).docx Supporting Statement A
CMS-10639 Supporting Statement B NHSN CY 2024 (10-26-2023).docx Supporting Statement B
CMS-10639 Supporting Statement B NHSN CY 2024 (10-26-2023).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

All Historical Document Collections

202401-0938-004 Approved without change	Revision of a currently approved collection	2024-01-19
202308-0938-008 Comment filed on proposed rule and continue	Revision of a currently approved collection	2023-08-15
202211-0938-005 Approved without change	Revision of a currently approved collection	2022-11-10
202207-0938-012 Comment filed on proposed rule and continue	Revision of a currently approved collection	2022-07-19
202111-0938-005 Approved without change	Revision of a currently approved collection	2021-11-10
202106-0938-015 Comment filed on proposed rule and continue	Revision of a currently approved collection	2021-07-12
202103-0938-012 Approved without change	Revision of a currently approved collection	2021-03-10
202007-0938-003 Comment filed on proposed rule and continue	Revision of a currently approved collection	2020-07-15
201912-0938-018 Approved with change	Revision of a currently approved collection	2019-12-23
201908-0938-002 Comment filed on proposed rule and continue	Revision of a currently approved collection	2019-08-27
201811-0938-006 Approved without change	Revision of a currently approved collection	2018-11-19
201809-0938-007 Comment filed on proposed rule and continue	Revision of a currently approved collection	2018-10-03
201805-0938-006 Approved with change	Revision of a currently approved collection	2018-05-08
201708-0938-005 Comment filed on proposed rule and continue	Revision of a currently approved collection	2017-08-07
201611-0938-014 Approved with change	New collection (Request for a new OMB Control Number)	2016-11-25