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Federal forms, ICRs, and supporting documents

Information Collection Request

Hospital Reporting Initiative--Hospital Quality Measures (CMS-10210)

ICR 202508-0938-019 · OMB 0938-1022 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-10210 THA/TKA Patient-Reported Outcome-based Performance Measure Form and Instruction Unchanged Repair queued
Form CMS-10210 Hospital Inpatient Quality Reporting Program Denominator Declaration Form and Instruction Unchanged Available
Form CMS-10210 Population and Sampling Form and Instruction Unchanged Available
Form CMS-10210 Maternal Morbidity Structural Measure Form and Instruction Unchanged Available
Form CMS-10210 Validation Educational Review Form Form and Instruction Unchanged Repair queued
Form CMS-10210 HVBP CMS Independent Review Form Form and Instruction Unchanged Available
Form CMS-10210 VBP Appeal Request Form Form and Instruction Unchanged Repair queued
Form CMS-10210 Validation Review for Reconsideration Request Form and Instruction Unchanged Available
Form CMS-10210 IQR Reconsideration Request Form Form and Instruction Unchanged Available
Form CMS-10210 IQR Notice of Participation Form Form and Instruction Unchanged Repair queued
Form CMS-10210 Hospital Compare Request Form for Withholding/Footnoting Data for Public Reporting Form and Instruction Unchanged Repair queued
Form CMS-10210 Extraordinary Circumstances Form Form and Instruction Unchanged Repair queued
Form CMS-10210 Hospital VPB Review and Corrections Form Form and Instruction Unchanged Available
Form CMS-10210 Data Accuracy and Completeness Form Form and Instruction Unchanged Repair queued
Form CMS-10210 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction Unchanged Missing upstream
CMS-10210 HIQR FY 2026 FR Supporting Statement B.docx Supporting Statement B Uploaded 2025-08-22 Repair queued
CMS-10210 HIQR FY 2026 FR Supporting Statement B.docx Supporting Statement B Uploaded 2025-08-22 Repair queued
CMS-10210 HIQR FY 2026 FR Supporting Statement A 8-7-25.docx Supporting Statement A Uploaded 2025-08-22 Repair queued
CMS-10210 HIQR FY 2026 FR Supporting Statement A 8-7-25.docx Supporting Statement A Uploaded 2025-08-22 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedTHA/TKA Patient-Reported Outcome-based Performance Measure
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedHospital Inpatient Quality Reporting Program Denominator Declaration
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedPopulation and Sampling
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedMaternal Morbidity Structural Measure
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedValidation Educational Review Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedHVBP CMS Independent Review Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedVBP Appeal Request Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedValidation Review for Reconsideration Request
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedIQR Reconsideration Request Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedIQR Notice of Participation Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedHospital Compare Request Form for Withholding/Footnoting Data for Public Reporting
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedExtraordinary Circumstances Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedHospital VPB Review and Corrections Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction UnchangedData Accuracy and Completeness Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction Unchanged
ICR Details
0938-1022 202508-0938-019
Active 202506-0938-015
HHS/CMS CCSQ
Hospital Reporting Initiative--Hospital Quality Measures (CMS-10210)
Revision of a currently approved collection   No
Regular
Approved without change 12/30/2025
Retrieve Notice of Action (NOA) 08/26/2025
  Inventory as of this Action Requested Previously Approved
12/31/2028 36 Months From Approved 01/31/2026
18,000 0 18,000
1,351,632 0 2,283,878
0 0 0
This request covers data collection requirements for the FY 2027 payment determination and subsequent years. This revised information collection request includes burden for the proposed adoption of the Age Friendly Hospital measure, the proposed increase in the number of eCQMs hospitals would be required to report, and the removal of the Measure Exception Form for NHSN HAI Measures from this information collection in addition to updated data and wage rates impacting previously approved burden calculations.
PL: Pub.L. 111 - 148 3001 Name of Law: Affordable Care Act
   PL: Pub.L. 109 - 171 5001(a) Name of Law: Hospital Quality Improvement
   PL: Pub.L. 108 - 173 5001(b) Name of Law: Medicare Prescription Drug, Improvement and Modernization Act of 2003
  
None
0938-AV45 Final or interim final rulemaking 90 FR 36536 08/04/2025
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 18,000 18,000 0 0 0 0
Annual Time Burden (Hours) 1,351,632 2,283,878 0 -932,246 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
For the CY 2026 reporting period/FY 2028 payment determination, based on the policies in the FY 2026 IPPS/LTCH PPS final rule, we estimate a total burden of 1,351,632 hours and $73,667,099 (a decrease of 953,644 hours and $25,051,078 from our estimate in the FY 2025 IPPS/LTCH PPS final rule). This burden estimate also represents a decrease of 932,246 hours and $18,465,446 from the currently approved burden estimate of 2,283,878 hours and $92,132,545 for the CY 2025 reporting period/FY 2027 payment determination.
$10,582,965
No
    No
    No
Yes
No
No
No
Denise King 410 786-1013 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/26/2025