OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program

IC 202342 under ICR 201209-0938-004 · OMB 0938-1175.

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

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 Notice of Participation PCHQR.NOP.Aug_26_2012.rvised.V1.0.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Data Accuracy and Completeness PCHQR.DACA form.Aug_27_2012.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10431 HAI Exception HAI Exception_Paper Form Aug_27_2012.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Decline to Participate PCHQR.DeclineParticipation.Aug_26_2012_.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10431 Withdrawal Withdrawalform.Aug_26_2012_.docx Yes Yes Fillable Fileable

Health Health Care Services

 

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

  Approved 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 27,273 27,273 0 0 0 0
Annual IC Time Burden (Hours) 68,182 68,182 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.