National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP)

National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) (CMS-10639)

Documents and Forms

Document Name Document Type
Form CMS-10639 National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) Form and Instruction
CMS-10639 Request Letter to Facilities Records CMS_10639_NHSN Request Letter to Facilities_Records_Template.docx Form and Instruction
CMS-10639 Request Letter to Facilities - List CMS-10639_NHSN Request Letter to Facilities_List_Template.docx Form and Instruction
CMS_10639_Message Introducing Contractor to All Facilities_template.docx Contractor Letter IC Document

Information Collection (IC) Details

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents:	Number of Respondents for Small Entity:

Affected Public:

Percentage of Respondents Reporting Electronically:

		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
Annual IC Time Burden (Hours)
Annual IC Cost Burden (Dollars)

Documents for IC

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.