Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(CMS-10804) QPP Site Intercept Survey New 1200 100 0 Form and Instruction CMS-10804 QPP Intercept Survey
CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) New 2000 167 4970 Form and Instruction CMS-10886 CCSQ Support Central Knowledge Research Survey
CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) New 2000 167 4970 Form and Instruction CMS-10896 CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) New 2800 93 0 Form and Instruction CMS-10818 Call Scheduling
Form and Instruction CMS-10818 Create a Ticket
Form and Instruction CMS-10818 Live Chat
Form and Instruction CMS-10818 Track Existing Ticket
Chat/CCSQ Support Central – Basic information questions (CMS-10832) New 10155 508 0 Form and Instruction CMS-10832 Support Central Screen shot
Customer Effort Scoring - Surveys (CMS-10833) New 4800 400 0 Form and Instruction CMS-10833 QualityNet-EQRS Help Desk Customer Feedback Survey
Form and Instruction CMS-10833 QualityNet Help Desk Customer Feedback Survey
Form and Instruction CMS-10833 QPP Customer Effort Questionnaire: 2020 Online Survey
Hospital Quality Reporting User Language Card Sort (CMS-10871) New 75 18 0 Form and Instruction CMS-10871 HQR User Language Card Sort
Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817) New 2000 67 0 Form and Instruction CMS-10817 HQR User Research Participation Survey
Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) New 2000 67 0 Form and Instruction CMS-10817 HQR User Research Participation Survey
Internet Quality Improvement and Evaluation System (IQIES) HCD User Research Form (CMS-10808) New 2000 167 0 Form and Instruction CMS-10808 iQies HCD User Research Form
Internet Quality Improvement and Evaluation System (IQIES) Idea Portal New 1000 83 0 Form and Instruction CMS-10810 Idea Portal
PY 23 QPP Submissions Intercept Survey (CMS-10838) New 1500 125 0 Form and Instruction CMS-10838 Submissions Intercept Survey Instrument
Form and Instruction CMS-10838 Submissions Intercept Survey Instrument
QPP Submissions Intercept Survey (CMS-10838) New 1500 125 0 Form and Instruction CMS-10838 Submissions Intercept Survey Questions
Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revision)) New 2000 6 0 Form and Instruction CMS-10800 Single Ease Question for User Insights on Hospital Quality Reporting
Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800) New 2000 6 0 Form and Instruction CMS-10800 HQR Touchpoints Survey
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 37030 2099 9940  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title