OMB control number

Generic Clearance for the Center for Clinical Standards and Quality IT Product and Support Teams (CMS-10706)

OMB 0938-1397 · HHS/CMS.

OMB 0938-1397

The CMS Center for Clinical Standards and Quality (CCSQ) is responsible for administering appropriate information systems so that the public can submit healthcare-related information. CMS is continually implementing and updating information systems as legislation and requirements change. To support this initiative, CIPST teams must have the capacity for engagement with users in an ongoing variety of research, discovery, and validation activities to create and refine systems that do not place an undue burden on users and instead are efficient, usable, and desirable. The primary CIPST users are not beneficiaries, but rather representatives of healthcare facilities who are responsible for disseminating aggregate healthcare data to CMS. The information collected from voluntary participants by CIPST product team members will help CMS CCSQ inform the design, selection, testing, modification, and expansion of innovative healthcare quality information systems. Because CMS employees, contractors, and partners are responsible for creating and improving human-centered products, services, and policies, by definition, they must engage with and gather regular feedback from the public for whom these products, services, and systems serve. The generic clearance will allow a rapid response to inform CMS initiatives using a mixture of qualitative and quantitative consumer research strategies (including formative research studies and methodological tests) to improve information systems that serve CMS audiences. CMS implements human-centered methods and activities for the improvement of policies, services, and products. As information systems and technologies are developed or improved upon, they can be tested and evaluated for end-user feedback regarding utility, usability, and desirability. The overall goal is to apply a human-centered engagement model to maximize the extent to which CMS CIPST product teams can gather ongoing feedback from consumers. Feedback helps engineers and designers arrive at better solutions, therefore minimizing the burden on consumers and meeting their needs and goals.

The latest form for Generic Clearance for the Center for Clinical Standards and Quality IT Product and Support Teams (CMS-10706) expires 2027-07-31 and is listed under ICR 202405-0938-010.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-10979 Customer AI Trust Survey (document unavailable)Form and Instruction
Form CMS-10967 Site-Intercept Survey (document unavailable)Form and Instruction
Form CMS-10965 QIO Participant Age-Friendly Survey (document unavailable)Form and Instruction
Form CMS-10965 Age Friendly Survey Scoring (document unavailable)Form and Instruction
Form CMS-10965 Age Friendly Readiness Assessment (document unavailable)Form and Instruction
Form CMS-10964 QualityNet Files Page Intercept Survey (document unavailable)Form and Instruction
Form CMS-10951 iQIES Data Request form (document unavailable)Form and Instruction
Form CMS-10936 Welcome Packet (document unavailable)Form and Instruction
Form CMS-10936 DAC Follow-up Communication Templates (document unavailable)Form and Instruction
Form CMS-10936 User Feedback Recruitment Flyer (document unavailable)Form and Instruction
Form CMS-10936 Provider Recruitment Flyer (document unavailable)Form and Instruction
Form CMS-10936 Webpage Patient and Caregiver User Feedback Session Interest Form (document unavailable)Form and Instruction
Form CMS-10936 Webpage Provider User Feedback Session Interest Form (document unavailable)Form and Instruction
Form CMS-10940 EPCS Webinar Survey (document unavailable)Form and Instruction
Form CMS-10939 EPCS Education & Outreach (E&O) Document Survey (document unavailable)Form and Instruction
Form CMS-10938 CCSQ Service Center Customer Experience Incident Survey (document unavailable)Form and Instruction
Form CMS-10937 QSEP Help Desk Form (document unavailable)Form and Instruction
Form CMS-10929 MADiE Survey (document unavailable)Form and Instruction
Form CMS-10928 Hospital Quality Reporting Communications Survey (document unavailable)Form and Instruction
Form CMS-10927 CQP Ideal Portal (document unavailable)Form and Instruction
Form CMS-10919 13th SOW QIN-QIO Focused QIO Service (FQS) Experience Survey (document unavailable)Form and Instruction
Form CMS-10919 13th SOW Rapid Cycle Experience Survey (document unavailable)Form and Instruction
Form CMS-10926 Qualtrics Survey - QEM (document unavailable)Form
Form CMS-10922 Support Central Post Webinar Survey (document unavailable)Form and Instruction
Form CMS-10920 EQRS Idea Portal Screen shots (document unavailable)Form and Instruction
Form CMS-10838 Survey Instrument - Submissions Intercept (document unavailable)Form and Instruction
Form CMS-10833 Service Center Customer Experience Survey (document unavailable)Form and Instruction
Form CMS-10907 Transplant Center Data Exchange Capabilities Survey (document unavailable)Form and Instruction
Form CMS-10904 HQR Idea Portal Form (document unavailable)Form and Instruction
Form CMS-10896 CCSQ Support Central Live Chat Virtual Agent SurveyForm and Instruction
Form CMS-10896 CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896)Form and Instruction
Form CMS-10886 CCSQ Support Central Knowledge Research SurveyForm and Instruction
Form CMS-10886 CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886)Form and Instruction
Form CMS-10800 Single Ease Question for User Insights on Hospital Quality ReportingForm and Instruction
Form CMS-10800 Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised)Form and Instruction
Form CMS-10871 HQR User Language Card SortForm and Instruction
Form CMS-10871 Hospital Quality Reporting User Language Card Sort (CMS-10871)Form and Instruction
Form CMS-10817 HQR User Research Participation SurveyForm and Instruction
Form CMS-10817 Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised)Form and Instruction
Form CMS-10838 Submissions Intercept SurveyForm and Instruction
Form CMS-10838 QPP Submissions Intercept Survey (CMS-10838)Form and Instruction
Form CMS-10832 Support Central screen shotsForm and Instruction
Form CMS-10832 Chat/CCSQ Support Central – Basic information questions (CMS-10832)Form and Instruction
Form CMS-10833 QPP Customer Effort Questionnaire: 2020 Online Survey (Draft 1)Form and Instruction
Form CMS-10833 QualityNet Help Desk Customer Feedback SurveyForm and Instruction
Form CMS-10833 QualityNet-EQRS Help Desk Customer Feedback SurveyForm and Instruction
Form CMS-10833 Customer Effort Scoring - Surveys (CMS-10833)Form and Instruction
Form CMS-10818 Track Existing TicketForm and Instruction
Form CMS-10818 Live ChatForm and Instruction
Form CMS-10818 Create A TicketForm and Instruction
Form CMS-10818 Call SchedulingForm and Instruction
Form CMS-10818 Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818)Form and Instruction
Form CMS-10810 Idea PortalForm and Instruction
Form CMS-10810 Internet Quality Improvement and Evaluation System (IQIES) Idea Portal (CMS-10810)Form and Instruction
Form CMS-10808 iQIES HCD User Research FormForm and Instruction
Form CMS-10808 Internet Quality Improvement and Evaluation System (iQIES) HCD User Research Form (CMS-10808)Form and Instruction
Form CMS-10804 QPP Site Intercept SurveyForm and Instruction
Form CMS-10804 Quality Payment Program Site Intercept Survey (CMS-10804)Form and Instruction
CMS-10706 Template_CCSQ Generic Clearance_07192021_clean copy.docx Supplementary Document
CMS-10706_SuppStmt_Part B_final 2-22-24 .docxSupporting Statement B
CMS-10706_SuppStmt_Part A_FINAL-2024-02-22.docxSupporting Statement A
CCSQ Service Center AI and Trust Research Survey (CMS-10979) Form and Instruction
CCSQ Support Central Site-Intercept Survey (CMS-10967) Form and Instruction
CMS Age-Friendly Readiness Assessment (CMS-10965) Form and Instruction
CMS Age-Friendly Readiness Assessment (CMS-10965) Form and Instruction
CMS Age-Friendly Readiness Assessment (CMS-10965) Form and Instruction
QualityNet Files Page Intercept Survey (CMS-10964) Form and Instruction
iQIES Data Request Portal (CMS-10951) Form and Instruction
Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction
Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction
Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction
Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction
Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction
Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) Form and Instruction
Electronic Prescribing of Controlled Substances (EPCS) Webinar Survey (CMS-10940) Form and Instruction
Electronic Prescribing of Controlled Substances (EPCS) - Education & Outreach (E&O) Document Survey (CMS-10939) Form and Instruction
CCSQ Service Center Customer Experience Incident Survey (CMS-10938) Form and Instruction
Contact Quality, Safety and Education Portal (QSEP) Help Desk (CMS-10937) Form and Instruction
System Usability Scale Survey for MADiE (CMS-10929) Form and Instruction
Hospital Quality Reporting Communications Survey (CMS-10928) Form and Instruction
Idea Portal for User Insights on CMS Quality Improvement Organization Platform (CQP) (CMS-10927) Form and Instruction
13th Statement of Work (SoW) Quality Improvement Network-Quality Improvement Organization (QIN-QIO) and American Indian/Alaska Native (AIAN-QIO) Provider Experience Encounter Survey (CMS-10919) Form and Instruction
13th Statement of Work (SoW) Quality Improvement Network-Quality Improvement Organization (QIN-QIO) and American Indian/Alaska Native (AIAN-QIO) Provider Experience Encounter Survey (CMS-10919) Form and Instruction
iQIES Post-Launch Sentiment Survey (CMS-10926) Instruction
iQIES Post-Launch Sentiment Survey (CMS-10926) Form
CCSQ Support Central Post-Webinar Customer Feedback Survey (CMS-10922) Form and Instruction
End Stage Renal Disease Quality Reporting System EQRS (EQRS) Idea Portal. (CMS-10920 Form and Instruction
QPP Submissions Intercept Survey (CMS-10838) Form and Instruction
Customer Experience Surveys (CMS-10833 revised) Form and Instruction
Transplant Center Data Exchange Capabilities Survey (CMS-10907) Form and Instruction
Idea Portal for User Insights on Hospital Quality Reporting (CMS-10904) Form and Instruction
CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) Form and Instruction
CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) Form and Instruction
CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) Form and Instruction
CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) Form and Instruction
Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised) Form and Instruction
Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised) Form and Instruction
Hospital Quality Reporting User Language Card Sort (CMS-10871) Form and Instruction
Hospital Quality Reporting User Language Card Sort (CMS-10871) Form and Instruction
Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) Form and Instruction
Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) Form and Instruction
QPP Submissions Intercept Survey (CMS-10838) Form and Instruction
QPP Submissions Intercept Survey (CMS-10838) Form and Instruction
Chat/CCSQ Support Central – Basic information questions (CMS-10832) Form and Instruction
Chat/CCSQ Support Central – Basic information questions (CMS-10832) Form and Instruction
Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction
Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction
Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction
Customer Effort Scoring - Surveys (CMS-10833) Form and Instruction
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) Form and Instruction
Internet Quality Improvement and Evaluation System (IQIES) Idea Portal (CMS-10810) Form and Instruction
Internet Quality Improvement and Evaluation System (IQIES) Idea Portal (CMS-10810) Form and Instruction
Internet Quality Improvement and Evaluation System (iQIES) HCD User Research Form (CMS-10808) Form and Instruction
Internet Quality Improvement and Evaluation System (iQIES) HCD User Research Form (CMS-10808) Form and Instruction
Quality Payment Program Site Intercept Survey (CMS-10804) Form and Instruction
Quality Payment Program Site Intercept Survey (CMS-10804) Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202405-0938-010 Extension without change of a currently approved collection 2024-05-09 Approved without change
202009-0938-002 New collection (Request for a new OMB Control Number) 2020-09-11 Approved with change

OMB Details

Quality Payment Program Site Intercept Survey (CMS-10804)

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form CMS-10804QPP Site Intercept SurveyFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.