CAHPS Survey for Physician Quality Reporting

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1222 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10450 CAHPS Survey for Physician Quality Reporting Form and Instruction
CMS-10450 CAHPS Suvery ._508 Attachment 1 Survey for PQRS OMB 2012-11-3.docx Form and Instruction
._508 Attachment 2 PQRS OMB Survey Cover Letters 2012-10-19.docx Cover Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CAHPS Survey for Physician Quality Reporting	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-10450	CAHPS Suvery	._508 Attachment 1 Survey for PQRS OMB 2012-11-3.docx		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 234,600	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	117,300	117,300
Annual IC Time Burden (Hours)	39,530	39,530
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cover Letter	._508 Attachment 2 PQRS OMB Survey Cover Letters 2012-10-19.docx	03/22/2013

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