Information Collection

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Survey

IC 189257 under ICR 200904-3206-007 · OMB 3206-0236.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0236 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Survey	Form and Instruction
0 cahps child questionnaire CAHPS 4.0H Child Commercial Questionnaire.doc	Form and Instruction
CAHPS survey SSB.doc supporting statement b	IC Document

IC Title:

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Â Child Survey

Agency IC Tracking Number:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0	cahps child questionnaire	CAHPS 4.0H Child Commercial Questionnaire.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
supporting statement b	CAHPS survey SSB.doc	05/22/2009

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