OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Inpatient Psychiatric Facility Quality Reporting Program

IC 202349 under ICR 201205-0938-005 · OMB 0938-1171.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Inpatient Psychiatric Facility Quality Reporting Program
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 10432 Participation, Decline to Participate, Withdrawal and Waiver Forms Appendices_forms.5-1-2012.docx Yes Yes Fillable Printable
Form 10432 Web-based Measure Online Data Entry Tool Content Data collection.docx Yes Yes Fillable Printable

Health Health Care Services

 

1,741 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 471,811 471,811 0 0 0 0
Annual IC Time Burden (Hours) 1,415,433 1,415,433 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Notification letter Notification Letter.docx 05/01/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.