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Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202604-0938-027 · OMB 0938-1022 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-10210 Age Friendly Structural Measure Form and Instruction Modified Available
Form CMS-10210 THA/TKA Patient-Reported Outcome-based Performance Measure Form and Instruction Modified Available
Form CMS-10210 Hospital Inpatient Quality Reporting Program Denominator Declaration Form and Instruction Modified Repair queued
Form CMS-10210 Population and Sampling Form and Instruction Modified Repair queued
Form CMS-10210 Maternal Morbidity Structural Measure Form and Instruction Modified Available
Form CMS-10210 Validation Educational Review Form Form and Instruction Modified Repair queued
Form CMS-10210 HVBP CMS Independent Review Form Form and Instruction Modified Repair queued
Form CMS-10210 VBP Appeal Request Form Form and Instruction Modified Repair queued
Form CMS-10210 Validation Review for Reconsideration Request Form and Instruction Modified Repair queued
Form CMS-10210 IQR Reconsideration Request Form Form and Instruction Modified Available
Form CMS-10210 IQR Notice of Participation Form Form and Instruction Modified Repair queued
Form CMS-10210 Hospital Compare Request Form for Withholding/Footnoting Data for Public Reporting Form and Instruction Modified Available
Form CMS-10210 Extraordinary Circumstances Form Form and Instruction Modified Available
Form CMS-10210 Hospital VPB Review and Corrections Form Form and Instruction Modified Repair queued
Form CMS-10210 Data Accuracy and Completeness Form Form and Instruction Modified Available
CMS-10210 HIQR FY 2027 Supporting Statement B.docx Supporting Statement B Uploaded 2026-05-20 Repair queued
CMS-10210 HIQR FY 2027 Supporting Statement A.docx Supporting Statement A Uploaded 2026-05-20 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedAge Friendly Structural Measure
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedTHA/TKA Patient-Reported Outcome-based Performance Measure
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedHospital Inpatient Quality Reporting Program Denominator Declaration
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedPopulation and Sampling
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedMaternal Morbidity Structural Measure
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedValidation Educational Review Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedHVBP CMS Independent Review Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedVBP Appeal Request Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedValidation Review for Reconsideration Request
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedIQR Reconsideration Request Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedIQR Notice of Participation Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedHospital Compare Request Form for Withholding/Footnoting Data for Public Reporting
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedExtraordinary Circumstances Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedHospital VPB Review and Corrections Form
204350 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction ModifiedData Accuracy and Completeness Form
ICR Details
0938-1022 202604-0938-027
Received in OIRA 202508-0938-019
HHS/CMS CCSQ
Hospital Reporting Initiative--Hospital Quality Measures (CMS-10210)
Revision of a currently approved collection   No
Regular 05/27/2026
  Requested Previously Approved
36 Months From Approved 12/31/2028
18,200 18,000
1,354,664 1,351,632
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-AV79 Proposed rulemaking 91 FR 19312 04/14/2026
No
  Total Request 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 18,200 18,000 0 200 0 0
Annual Time Burden (Hours) 1,354,664 1,351,632 0 3,032 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
For the CY 2027 reporting period/FY 2029 payment determination, based on the proposed policies in the FY 2027 IPPS/LTCH PPS proposed rule, we estimate a total burden of 1,354,664 hours and $73,424,664 (a decrease of 1 hour due to rounding from our estimate in the FY 2026 IPPS/LTCH PPS final rule). This burden estimate represents an increase of 3,032 hours and $242,435 from the currently approved burden estimate of 1,351,632 hours and $73,667,099 for the CY 2026 reporting period/FY 2028 payment determination.
$538,293
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.
05/27/2026