CAHPS Home Health Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Responses to OMB questions_HomeHealthCAHPS_30June2009.doc	Supplementary Document	Uploaded 2009-07-02	Available
HomeHealthCAHPS_OMB_PartB_revised_01july09.doc	Supporting Statement B	Uploaded 2009-07-02	Available
Home Health CAHPS Responses to Public Comments 3-17-09--Comment Topics.doc	Supplementary Document	Uploaded 2009-04-10	Available
Home Health CAHPS OMB Changes to the Supporting Statement Recommended by NQF 3-30-09.(2).doc	Supplementary Document	Uploaded 2009-04-10	Available
TRK Home Health CAHPS OMB Package Track Changes after NQF 3-30-09.doc	Supplementary Document	Uploaded 2009-04-10	Available
HomeHealthCAHPS_OMB_PartA-revised_july09.doc	Supporting Statement A	Uploaded 2009-07-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188901	CAHPS Home Health Care Survey (CMS-10275)	Other-Survey and Questionnaires	New

ICR Details

OMB Control No: 0938-1066	ICR Reference No: 200904-0938-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: CAHPS Home Health Care Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/18/2009
	Date Received in OIRA: 04/22/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2012	36 Months From Approved
Responses	2,706,000	0	0
Time Burden (Hours)	541,200	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: As part of the DHHS Transparency Initiative on Quality Reporting, CMS plans to implement a process to measure and publicly report patients' experiences with home health care they receive from Medicare-certified home health agencies. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home Health Care Survey is a standardized survey for home health patients to assess their home health care providers and the quality of the home health care they receive. This collection package covers the voluntary implementation of the survey among Medicare-certified agencies and a randomized mode experiment to test the impact of different modes of data collection on survey responses.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: US Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 903	01/09/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 16401	04/10/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
CAHPS Home Health Care Survey (CMS-10275)

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ICR Summary of Burden

table that charts list of burden

	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	2,706,000	0	0	2,706,000	0	0
Annual Time Burden (Hours)	541,200	0	0	541,200	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New collection

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Annual Cost to Federal Government: $1,765,634

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/22/2009

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