In-Center Hemodialysis CAHPS Survey: Mode

In-Center Hemodialysis CAHPS Survey

OMB: 0938-0926

IC ID: 8773

Information Collection (IC) Details

View Information Collection (IC)

In-Center Hemodialysis CAHPS Survey: Mode
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10105 Attachment C - Final ICH CAHPS Survey (English and Spanish) Attachment C - Final ICH CAHPS Survey (English and Spanish).docx Yes No Fillable Printable
Form CMS-10105 Attachment E - Telephone Script (English and Spanish) Attachment E - ICH CAHPS Telephone Script (English and Spanish).docx No No Printable Only

Health Health Care Services

 

5,000 0
   
Individuals or Households
 
   45 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,000 0 5,000 0 0 0
Annual IC Time Burden (Hours) 1,350 0 1,350 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment D - Cover Letter for Mode Experiment (English and Spanish) Attachment D - ICH CAHPS Cover Letter for Mode Experiment (English and Spanish).docx 07/05/2013
Attachment F - Pre-Notification Letter for Mode Experiment (English and Spanish) Attachment F - Pre-Notification Letter for Mode Experiment (English and Spanish).docx 07/05/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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