Information Collection

CAHPS Survey for Physician Quality Reporting

IC 206234 under ICR 201303-0938-016 · OMB 0938-1222.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.