Information Collection

Pretest of Proposed CAHPS for Cancer Care Questions and Methodology

IC 200167 under ICR 201104-0935-002 · OMB 0935-0124.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0124 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #1 Pretest of Proposed CAHPS for Cancer Care Questions and Methodology	Form and Instruction
Form #1 CAHPS Cancer Care Questionnaires Attachment A - CAHPS Cancer Care Questionnaires 11-2-2011.docx	Form and Instruction
Attachment B - Cover Letter, Reminder Letter, and Phone Invitation Letter.doc Attachment B - Cover Letter, Reminder Letter, and Phone Invitation Letter	IC Document
Attachment C - Phone Call Reminder Script for Mailed Survey Non-respondents.doc Attachment C - Phone Call Reminder Script for Mailed Survey Non-respondents	IC Document
Supporting Statement A -- Pretest of Proposed CAHPS Cancer Questionnaires 9-27-11.doc Supporting Statement A	IC Document
Supporting Statement B -- Pretest of Proposed CAHPS Cancer Questionnaires 9-27-11.doc Supporting Statement B	IC Document

IC Title:

Pretest of Proposed CAHPS for Cancer Care Questions and Methodology

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	Form #1	CAHPS Cancer Care Questionnaires	Attachment A - CAHPS Cancer Care Questionnaires 11-2-2011.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,800

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	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,800	0	0	0	0	0
Annual IC Time Burden (Hours)	600	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment B - Cover Letter, Reminder Letter, and Phone Invitation Letter	Attachment B - Cover Letter, Reminder Letter, and Phone Invitation Letter.doc	11/14/2011
Attachment C - Phone Call Reminder Script for Mailed Survey Non-respondents	Attachment C - Phone Call Reminder Script for Mailed Survey Non-respondents.doc	11/14/2011
Supporting Statement A	Supporting Statement A -- Pretest of Proposed CAHPS Cancer Questionnaires 9-27-11.doc	11/21/2011
Supporting Statement B	Supporting Statement B -- Pretest of Proposed CAHPS Cancer Questionnaires 9-27-11.doc	11/21/2011

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