Information Collection

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Adults

IC 192585 under ICR 200908-3206-001 · OMB 3206-0253.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0253 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) Adults	Form and Instruction
0 Consumer Assessment of Healthcare Providers and Systems CAHPS 4.0H Adult 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 Adults

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	Consumer Assessment of Healthcare Providers and Systems (CAHPS) ï¿½ Adults	CAHPS 4.0H Adult Commercial_Questionnaire.doc		No		Paper Only

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 210,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	210,000	210,000
Annual IC Time Burden (Hours)	70,000	70,000
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	04/15/2010

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