Information Collection

CAHPS Home Health Care Survey (CMS-10275)

IC 188901 under ICR 201011-0938-018 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
HomeHealthCAHPS_OMB_PartC revised 6-24-10.pdf	Other-CAHPS Mail and Phone Survey an

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:

table that charts list of 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					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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
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.

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