National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) CMS-10102

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10102 National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS)	Form and Instruction	Modified	Available
Form CMS-10102 National Implementation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) CMS-10102	Form and Instruction	New	Available
CMS-10209.REVISED (CLEAN) HCAHPS Supporting Statement Part B.doc	Supporting Statement B	Uploaded 2012-06-25	Available
CMS-10102_Supporting_Statement_Part_A.pdf	Supporting Statement A	Uploaded 2012-04-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8843	National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS)	Form and Instruction	Modified
202110	National Implementation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) CMS-10102	Form and Instruction	New

ICR Details

OMB Control No: 0938-0981	ICR Reference No: 201204-0938-008
Status: Historical Active	Previous ICR Reference No: 201102-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) CMS-10102
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/02/2012
	Date Received in OIRA: 04/30/2012
Terms of Clearance: Upon next submission, the results of the mode experiment should be included in Supporting Statement A.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	36 Months From Approved	06/30/2014
Responses	2,713,812	0	2,480,000
Time Burden (Hours)	365,145	0	289,342
Cost Burden (Dollars)	31,748,403	0	15,100,000

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Abstract: The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals collect information on patient satisfaction, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals.

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Authorizing Statute(s): PL: Pub.L. 109 - 171 1886(b)(3)(B) Name of Law: Deficit Reduction Act of 2005
   PL: Pub.L. 111 - 148 3001 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 59133	09/23/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 25182	04/27/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS)	CMS-10102, CMS-10102, CMS-10102	Appendix C ,   Appendix A ,   Appendix B
National Implementation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) CMS-10102	CMS-10102, CMS-10102, CMS-10102	Appendix B ,   Appendix A ,   Appendix C

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,713,812	2,480,000	0	0	233,812	0
Annual Time Burden (Hours)	365,145	289,342	0	0	75,803	0
Annual Cost Burden (Dollars)	31,748,403	15,100,000	0	0	16,648,403	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $2,500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/30/2012

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