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

View Information Collection (IC)

Quality Measures and Procedures for Hospital Reporting of Quality Data
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 10210 Data Accuracy Form DACAForm2015_Final.doc Yes Yes Fillable Fileable
Form and Instruction 10210 Notice of Participation Notice of Participation.docx Yes Yes Fillable Fileable
Form and Instruction 10210 Data Validation Appeal Form HospQuarterlyValidAppeal_Part1.doc Yes Yes Fillable Fileable
Form and Instruction 10210 Extraordinary Circumstances/Waiver Request Form ExtraordinaryCircumstance.docx Yes Yes Fillable Fileable
Form 10210 Healthcare Associated Infection Exception Form HAI Exception.docx Yes Yes Fillable Fileable
Form and Instruction 10210 Reconsideration Request ReconsiderationRequest.docx Yes Yes Fillable Fileable
Form and Instruction 10210 Validation Review for Reconsideration Request Recon Request_Part 2.doc Yes Yes Fillable Fileable
Form and Instruction 10210 Inpatient Hospital Compare INPT_Apr2012_withholding_March[1].pdf Yes Yes Paper Only

Health Public Health Monitoring

 

4,400 0
   
Private Sector Businesses or other for-profits
 
   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 17,600 0 0 0 17,600 0
Annual IC Time Burden (Hours) 6,750,000 0 0 0 6,750,000 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.