Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Quality Measures and Procedures for Hospital Reporting of Quality Data Unchanged 17600 6050000 0 Form and Instruction CMS-10210 Data Accuracy and Completeness Acknowledgemenmt
Form and Instruction CMS-10210 HVBP Review and Corrections Form
Form and Instruction CMS-10210 HVBP Appeal Request Form
Form and Instruction CMS-10210 Validation Template CAUTI
Form and Instruction CMS-10210 Validation Template MRSA
Form and Instruction CMS-10210 Validation Template CLABSI
Form and Instruction CMS-10210 Validation Template CDI
Form and Instruction CMS-10210 Request for Withholding Data from Public Reporting
Form and Instruction CMS-10210 Reconsideration Request Form electronic
Form and Instruction CMS-10210 Extroadinary Circumstances Disaster Waiver
Form and Instruction CMS-10210 Healthcare Associated Infection Exception Form
Form and Instruction CMS-10210 HVBP Appeal Request Form Screen Shot
Form and Instruction CMS-10210 HVBP Review and Correction Rquest Form Screen Shot
Form and Instruction CMS-10210 HIQR Notice of Participation Form
Form and Instruction CMS-10210 Reconsideration Request Form
Total burden requested under this ICR: 17600 6050000 0  
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