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

View Information Collection (IC)

Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10390 Yes Yes Fillable Fileable
Form and Instruction CMS-10390 Yes Yes Fillable Fileable
Form and Instruction CMS-10390 Yes Yes Fillable Fileable
Form and Instruction CMS-10390 Yes Yes Fillable Fileable

Health Health Care Services

 

3,742 3,555
   
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 3,742 0 110 0 0 3,632
Annual IC Time Burden (Hours) 525,827 0 -131,565 0 0 657,392
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
User Guide for Hospice Quality Reporting Data Collection 08/07/2012
Technical User's Guide for Hospice Quality Reporting Data Entry and Submission 08/07/2012
Hospice Burden Estimate 05/28/2013
Exhibit B- Burden Calculation from 2013 05/28/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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