Sickle Cell Disease Treatment Demonstration Program - Quality Improvement Data Collection for the Hemoglobinopathy Learning Collaborative

Sickle Cell Disease Treatment Demonstration Program QI Measures

OMB: 0915-0359

IC ID: 204731

Information Collection (IC) Details

View Information Collection (IC)

Sickle Cell Disease Treatment Demonstration Program - Quality Improvement Data Collection for the Hemoglobinopathy Learning Collaborative
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Participant Profile Appendix C Participant Profile.pdf Yes Yes Fillable Fileable Signable
Form 2 Acute Care Visit Appendix D Acute Care Visit.pdf Yes Yes Fillable Fileable Signable
Form 3 Ambulatory Care Visit Appendix E Ambulatory Care Visit.pdf Yes Yes Fillable Fileable Signable

Health Health Care Services

 

27 0
   
Private Sector 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 324 0 324 0 0 0
Annual IC Time Burden (Hours) 2,700 0 2,700 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix A PLAW-108publ357_ACA2004_Section712 Appendix A PLAW-108publ357_ACA2004_Section712.pdf 10/23/2012
Appendix B Measure Bank Appendix B Measure Bank.pdf 10/23/2012
Appendix F and G_ SCDTDP expert panel members and TWG tables Appendix F and G_ SCDTDP expert panel members and TWG tables.pdf 10/23/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy