Information Collection Request

Evaluation of Patient Satisfaction and Experience of Care for Medicare Beneficiaries with ESRD: Impact of the ESRD Prospective Payment System (PPS) and ESRD Quality Incentive Program (QIP)

ICR 201210-0938-007 · OMB 0938-1206 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Attachment D - BeneSurveyCrosswalk - for OMB Item 10 (Revised July 19, 2013).xlsx Supplementary Document Uploaded 2013-08-09 Available
Supporting Statement Part B - ESRD SBRD (Revised July 18 2013).docx Supporting Statement B Uploaded 2013-08-09 Available
BeneSurveyCrosswalk - 080812.xlsx Supplementary Document Uploaded 2012-09-24 Available
ESRD_survey_draft_cover_letter_080212.pdf Supplementary Document Uploaded 2012-09-24 Available
Supporting Statement Part A - ESRD SBRD (Revised July 18 2013).docx Supporting Statement A Uploaded 2013-08-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
204531 Evaluation of Patient Satisfaction and Experience of Care for Medicare Beneficiaries with ESRD Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2016 36 Months From Approved
2,540 0 0
662 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Evaluation of Patient Satisfaction and Experience of Care for Medicare Beneficiaries with ESRD

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 2,540 0 0 2,540 0 0
Annual Time Burden (Hours) 662 0 0 662 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No