Evaluation of Patient Satisfaction and Experience of Care for Medicare Beneficiaries with ESRD

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)

Documents and Forms

Document Name Document Type
Attachment_B_08_02_12.pdf Instruction
Attachment_C_03-13-12.pdf Instruction
ESRD_Stakeholder_Interview_Recruiting_Script_Phone_and_Email.pdf Instruction
ESRD_survey_draft_cover_letter_080212.pdf ESRD Cover Letter IC Document

Information Collection (IC) Details

IC Title:	Evaluation of Patient Satisfaction and Experience of Care for Medicare Beneficiaries with ESRD	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Attachment_B_08_02_12.pdf	No	No	Paper Only
Instruction	Attachment_C_03-13-12.pdf	No	No	Paper Only
Instruction	ESRD_Stakeholder_Interview_Recruiting_Script_Phone_and_Email.pdf	No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,540	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,540	2,540
Annual IC Time Burden (Hours)	662	662
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ESRD Cover Letter	ESRD_survey_draft_cover_letter_080212.pdf	09/24/2012

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