CAHPS Health Plan Health Literacy Module

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

Documents and Forms

Document Name Document Type
Form Form #1 CAHPS Health Plan Health Literacy Module Form and Instruction
Form #1 CAHPS Health Plan Health Literacy Survey-- English Attachment B -- CAHPS Health Plan Health Literacy Survey -- English.docx Form and Instruction
Form #2 CAHPS Health Plan Health Literacy Survey -Spanish Attachment C -- CAHPS Health Plan Health Literacy Survey -- Spanish.doc Form and Instruction
Attachment D -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script - English&Spanish.docx Attachment D -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script - English&Spanish IC Document

Information Collection (IC) Details

IC Title:	CAHPS Health Plan Health Literacy Module	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 Plan Health Literacy Survey-- English	Attachment B -- CAHPS Health Plan Health Literacy Survey -- English.docx		Yes	Yes	Paper Only
Form and Instruction	Form #2	CAHPS Health Plan Health Literacy Survey -Spanish	Attachment C -- CAHPS Health Plan Health Literacy Survey -- Spanish.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	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	1,000	1,000
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment D -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script - English&Spanish	Attachment D -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone Script - English&Spanish.docx	09/20/2011

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