Information Collection

CAHPS Home Health Care Survey (CMS-10275)

IC 188901 under ICR 201007-0938-011 · OMB 0938-1066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1066 can be found here:

Documents and Forms

Document Name Document Type
HomeHealthCAHPS_OMB_PartC revised 6-24-10.pdf Other-CAHPS Mail and Phone Survey an

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CAHPS Home Health Care Survey (CMS-10275)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-CAHPS Mail and Phone Survey and Survey Questionnaires			HomeHealthCAHPS_OMB_PartC revised 6-24-10.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,706,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	2,706,000	2,706,000
Annual IC Time Burden (Hours)	541,200	541,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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