View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10431 Oncology Care Measures Online Data Entry Tool Data collection Feb_7_2013.Oncology Care Measures.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Surgical Care Improvement Online Data Entry Tool Data collection Feb_7_2013.SCIP.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Surgical Care Improvement Paper Submission Data Collection.Paperbased form.SCIP.Feb_08_2013.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Oncology Care Paper Submission Data collectionFeb_8_2013.Oncology Care Measures.Paper Form.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Extroadinary Circumstances/Disaster Extension or Waiver Request Form ExtraordinaryCircumstance Waiver.Application.Jan_16_2013.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Extroadinary Circumstance Paper Form ExtraordinaryCircumstance Waiver.Paper submission.Feb_8_2013.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Measure Exception Form Measure Waiver.Feb_8_2013.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Notice of Participation Paper Form NoP Paper Form.April_26_2013.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Data Accuracy and Completeness Agreement PCHQR.DACA form.Paper.Feb_8_2013.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Data Accuracy and Completeness Agreement Screen Shot PCHQR_DACA Application March_11_2013.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Notice of Participation Screenshot PCHQR_NOP application March_12_2013.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

11 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 63,468 0 36,195 0 0 27,273
Annual IC Time Burden (Hours) 602,965 0 534,783 0 0 68,182
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk CMS PCH Crosswalk.March_14_2013.pdf 05/15/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.