Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Hospital Outpatiennt Quality Data Program - Data Validation (CY 2017) Removed 0 0 0
Hospital Outpatient Quality Data Program - Administrative (CY 2017) Removed 0 0 0
Hospital Outpatient Quality Data Program - Data Abstraction (CY 2014) Removed 0 0 0
Hospital Outpatient Quality Data Program - Data Abstraction (CY 2015) Removed 0 0 0
Hospital Outpatient Quality Data Program - Data Abstration (CY 2016) Removed 0 0 0
Hospital Outpatient Quality Data Program - Data Validation (CY 2014) Removed 0 0 0
Hospital Outpatient Quality Data Program - Data Validation (CY 2015) Removed 0 0 0
Hospital Outpatient Quality Data Program - Data Validation (CY 2016) Removed 0 0 0
Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014) Removed 0 0 0 Form and Instruction CMS-10250 Request for Reconsideration Part 1
Form and Instruction CMS-10250 Request for Reconsideration Part 2
Form and Instruction CMS-10250 Extroadinary Circumstances
Form and Instruction CMS-10250 Notice of Participation
Hospital Outpatient Quality Data Program - Notice of Participation (CY 2015) Removed 0 0 0 Form and Instruction CMS-10250 Notice of Participation
Hospital Outpatient Quality Data Program - Notice of Participation Web based (CY 2017) Removed 0 0 0
Hospital Outpatient Quality Data Program -- Data Abstration (CY 2017) Removed 0 0 0
Hospital Outpatient Quality Data Program -Web based OP-31 (CY 2017) Removed 0 0 0
Hospital Outpatient Quality Program - Notice of Participation (CY 2016) Removed 0 0 0 Form and Instruction CMS-10250 Notice of Participation
Hospital Outpatient Quality Reporting CY 2016 - CY 2018 New 1708260 1503865 0 Form and Instruction CMS-10250 Extroadinary Circumstances Form
Form and Instruction CMS-10250 Notice of Participation Form
Form and Instruction CMS-10250 Validation Review for Reconsideration Request
Form and Instruction CMS-10250 Reconsideration Request Form
Total burden requested under this ICR: 1708260 1503865 0  
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