Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Inpatient Psychiatric Facility Quality Reporting Program Modified 596200 2279200 0 Form and Instruction CMS-10432 Reconsideration Request Form
Form and Instruction CMS-10432 Data Accuracy and Completeness
Form and Instruction CMS-10432 Data Accuracy and Completeness Screen Shots
Form and Instruction CMS-10432 HBIS Structural Measure Data Collection
Form and Instruction CMS-10432 HBIPS-2 Measure Screen Shot
Form and Instruction CMS-10432 Decline to Participate
Form and Instruction CMS-10432 Extroadinary Circumstance/Waiver Request Form
Form and Instruction CMS-10432 Notice of Participation Screen Shot
Form and Instruction CMS-10432 Notice of Participation
Form and Instruction CMS-10432 Vendor Authorization Screen Shot
Form and Instruction CMS-10432 Vendor Authorization
Form and Instruction CMS-10432 Withdrawal of Participation
Total burden requested under this ICR: 596200 2279200 0  
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