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 can be found here.
Latest Forms, Documents, and Supporting Material
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Form CMS-10639 Request Letter to Facilities - List
National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) All Historical Document Collections