Information Collection

National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS)

IC 8843 under ICR 200709-0938-009 · OMB 0938-0981.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0981 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10102 OMB2007 - CAHPS Hospital Survey (English) with disclosure.doc	Other-Survey English
CMS-10102 OMB2007 - CAHPS Hospital Survey (Spanish) with disclosure.doc	Other-Survey Spanish
CMS-10102 OMB2007 - CAHPS Hospital Survey (Chinese).pdf	Other-Survey Chinese
CMS-10102 OMB2007 - CAHPS Hospital Survey (Chinese) disclosure statement.doc CMS-10102 OMB2007 - CAHPS Hospital Survey (Chinese) disclosure statement	IC Document
CMS-10102 OMB2007 - Interactive Voice Response Script.doc CMS-10102 OMB2007 - Interactive Voice Response Script	IC Document
CMS-10102 OMB2007 - Telephone Script_English.doc CMS-10102 OMB2007 - Telephone Script_English	IC Document
CMS-10102 OMB2007 - Telephone Script_Spanish.doc CMS-10102 OMB2007 - Telephone Script_Spanish	IC Document

IC Title:

National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey English	CMS-10102 OMB2007 - CAHPS Hospital Survey (English) with disclosure.doc	Yes	Yes	Paper Only
Other-Survey Spanish	CMS-10102 OMB2007 - CAHPS Hospital Survey (Spanish) with disclosure.doc	Yes	Yes	Paper Only
Other-Survey Chinese	CMS-10102 OMB2007 - CAHPS Hospital Survey (Chinese).pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,820,000

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	Previously Approved
Annual Number of Responses for this IC	2,820,000	-32,000	2,852,000
Annual IC Time Burden (Hours)	329,940	44,740	285,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10102 OMB2007 - CAHPS Hospital Survey (Chinese) disclosure statement	CMS-10102 OMB2007 - CAHPS Hospital Survey (Chinese) disclosure statement.doc	09/22/2007
CMS-10102 OMB2007 - Interactive Voice Response Script	CMS-10102 OMB2007 - Interactive Voice Response Script.doc	09/22/2007
CMS-10102 OMB2007 - Telephone Script_English	CMS-10102 OMB2007 - Telephone Script_English.doc	09/22/2007
CMS-10102 OMB2007 - Telephone Script_Spanish	CMS-10102 OMB2007 - Telephone Script_Spanish.doc	09/22/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.