Amended CAHPS Survey

Evaluation and Development of Outcome Measures for Quality Assessment in Medicare Advantage and Special Needs Plans

Documents and Forms

Document Name Document Type
Form CMS-10451 Amended CAHPS Survey Form and Instruction
CMS-10451 Instruments CMS-10451.Instrument.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Amended CAHPS Survey	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	CMS-10451	Instruments	CMS-10451.Instrument.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.