Medicare Consumer Assessment of Health Plan Survey - Fee for Service (CAHPS-FFS)

ICR 200005-0938-002

OMB: 0938-0796

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0796 200005-0938-002
Historical Active
HHS/CMS
Medicare Consumer Assessment of Health Plan Survey - Fee for Service (CAHPS-FFS)
New collection (Request for a new OMB Control Number)   No
Emergency 07/01/2000
Approved without change 07/18/2000
Retrieve Notice of Action (NOA) 05/03/2000
  Inventory as of this Action Requested Previously Approved
05/31/2001 05/31/2001
134,400 0 0
44,800 0 0
0 0 0

Under the Balanced Budget Act of 1997, HCFA is required to provide general and plan comparative information to beneficiaries that will help them make more informed health plan choices. A CAHPS fee-for-service survey is needed to provide information comparable to those data collected from the CAHPS managed care survey.

None
None


No

1
IC Title Form No. Form Name
Medicare Consumer Assessment of Health Plan Survey - Fee for Service (CAHPS-FFS) HCFA-10000

  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 134,400 0 0 134,400 0 0
Annual Time Burden (Hours) 44,800 0 0 44,800 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
05/03/2000


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