Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
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) New 26003 7534 0 Form and Instruction CMS-10919 13th SOW Rapid Cycle Experience Survey
Form and Instruction CMS-10919 13th SOW QIN-QIO Focused QIO Service (FQS) Experience Survey
CCSQ Service Center Customer Experience Incident Survey (CMS-10938) New 150 8 0 Form and Instruction CMS-10938 CCSQ Service Center Customer Experience Incident Survey
CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) New 2000 167 0 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 0 Form and Instruction CMS-10896 CCSQ Support Central Live Chat Virtual Agent Survey
CCSQ Support Central Post-Webinar Customer Feedback Survey (CMS-10922) New 90 3 0 Form and Instruction CMS-10922 Support Central Post Webinar 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 shots
Contact Quality, Safety and Education Portal (QSEP) Help Desk (CMS-10937) New 1007 37 0 Form and Instruction CMS-10937 QSEP Help Desk Form
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 (Draft 1)
Customer Experience Surveys (CMS-10833 revised) New 4800 400 0 Form and Instruction CMS-10833 Service Center Customer Experience Survey
End Stage Renal Disease Quality Reporting System EQRS (EQRS) Idea Portal. (CMS-10920 New 1000 83 0 Form and Instruction CMS-10920 EQRS Idea Portal Screen shots
Hospital Quality Reporting Communications Survey (CMS-10928) New 300 60 0 Form and Instruction CMS-10928 Hospital Quality Reporting Communications 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 revised) New 2000 67 0 Form and Instruction CMS-10817 HQR User Research Participation Survey
Idea Portal for User Insights on CMS Quality Improvement Organization Platform (CQP) (CMS-10927) New 1000 33 0 Form and Instruction CMS-10927 CQP Ideal Portal
Idea Portal for User Insights on Hospital Quality Reporting (CMS-10904) New 2000 67 0 Form and Instruction CMS-10904 HQR Idea Portal Form
Internet Quality Improvement and Evaluation System (IQIES) Idea Portal (CMS-10810) New 1000 83 0 Form and Instruction CMS-10810 Idea Portal
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
QPP Submissions Intercept Survey (CMS-10838) New 1500 125 0 Form and Instruction CMS-10838 Survey Instrument - Submissions Intercept
QPP Submissions Intercept Survey (CMS-10838) New 1500 125 0 Form and Instruction CMS-10838 Submissions Intercept Survey
Quality Payment Program Site Intercept Survey (CMS-10804) New 1200 100 0 Form and Instruction CMS-10804 QPP Site Intercept Survey
Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised) New 2000 6 0 Form and Instruction CMS-10800 Single Ease Question for User Insights on Hospital Quality Reporting
System Usability Scale Survey for MADiE (CMS-10929) New 60 10 0 Form and Instruction CMS-10929 MADiE Survey
Transplant Center Data Exchange Capabilities Survey (CMS-10907) New 225 75 0 Form and Instruction CMS-10907 Transplant Center Data Exchange Capabilities Survey
iQIES Post-Launch Sentiment Survey (CMS-10926) New 200 7 0 Form CMS-10926 Qualtrics Survey - QEM
Instruction
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 69865 10343 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 1268 117 0  
To view an IC, click on IC Title