Mail survey with reminder card, mail and phone follow-up

Health Literacy Item Set Supplemental to CAHPS Hospital Survey - Pretest of Proposed Questions and Methodology

Documents and Forms

Document Name Document Type
Form Form #1 Mail survey with reminder card, mail and phone follow-up Form and Instruction
Form #1 CAHPS Health Literacy Survey Instrument Attachment B -- CAHPS Health Literacy Survey Instrument.doc Form and Instruction
Attachment C -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script.doc Attachment C -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script IC Document

Information Collection (IC) Details

IC Title:	Mail survey with reminder card, mail and phone follow-up	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #1	CAHPS Health Literacy Survey Instrument	Attachment B -- CAHPS Health Literacy Survey Instrument.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment C -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script	Attachment C -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script.doc	07/28/2009

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