Information Collection

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

IC 8843 under ICR 201204-0938-008 · OMB 0938-0981.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0981 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10102 Appendix C National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS)	Form and Instruction
Form CMS-10102 Appendix A National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS)	Form and Instruction
Form CMS-10102 Appendix B National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS)	Form and Instruction
CMS-10102 Appendix C CMS-10102_Supporting_Statement_Part_A_(Appendix_C).pdf	Form and Instruction
CMS-10102 Appendix A CMS-10102_Supporting_Statement_Part_A_(Appendix_A).pdf	Form and Instruction
CMS-10102 Appendix B CMS-10102_Supporting_Statement_Part_A_(Appendix_B).pdf	Form and Instruction

IC Title:

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

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10102	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10102	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10102	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,710,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,710,000	230,000	2,480,000
Annual IC Time Burden (Hours)	361,333	71,991	289,342
Annual IC Cost Burden (Dollars)	16,500,403	1,400,403	15,100,000

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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