Information Collection

Pilot Of The Hcahps/shep Satisfaction Survey Instruments

IC 181241 under ICR 200707-2900-039 · OMB 2900-0707.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-21083a(NR) PILOT OF THE HCAHPS/SHEP SATISFACTION SURVEY INSTRUMENTS	Form
10-21083a(NR) HCAHPS Survey 10-21083a (1).pdf	Form
10-21083b (NC) HCAHPS survey plus SHEP items not covered in HCAHPS 10-21083b.pdf	Form
10-21083c(NR) HCAHPS and full SHEP Inpatient survey 10-21083c(1).pdf	Form
10-21083d(NR) Current SHEP Inpatient document in 2 column format 10-21083d.pdf	Form
10-21083e(NR) Current SHEP Inpatient document in 1 column format 10-21083e.pdf	Form

IC Title:

PILOT OF THE HCAHPS/SHEP SATISFACTION SURVEY INSTRUMENTS

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	10-21083a(NR)	HCAHPS Survey	10-21083a (1).pdf	No	Paper Only
Form	10-21083b (NC)	HCAHPS survey plus SHEP items not covered in HCAHPS	10-21083b.pdf	No	Paper Only
Form	10-21083c(NR)	HCAHPS and full SHEP Inpatient survey	10-21083c(1).pdf	No	Paper Only
Form	10-21083d(NR)	Current SHEP Inpatient document in 2 column format	10-21083d.pdf	No	Paper Only
Form	10-21083e(NR)	Current SHEP Inpatient document in 1 column format	10-21083e.pdf	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,250	7,250
Annual IC Time Burden (Hours)	3,625	3,625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.