CAHPS Home Health Care Survey (CMS-10275)

CAHPS Home Health Care Survey

OMB: 0938-1066

IC ID: 188901

Information Collection (IC) Details

View Information Collection (IC)

CAHPS Home Health Care Survey (CMS-10275)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10275 Home Health Care CAHPS Survey (English) HHCAHPS_Questionnaire_English.pdf Yes Yes Fillable Printable
Form CMS-10275 Home Health Care CAHPS Survey (Russian) HHCAHPS_Questionnaire_Russian.pdf Yes Yes Fillable Printable
Form CMS-10275 Home Health Care CAHPS Survey (Spanish) HHCAHPS_Questionnaire_Spanish.pdf Yes Yes Fillable Printable
Form CMS-10275 Home Health Care CAHPS Survey (Telephone) HHCAHPS_TelephoneScript_English.pdf No No Fillable Printable
Form CMS-10275 Home Health Care CAHPS Survey (Telephone/Proxy) HHCAHPS_TelephoneScriptProxy_English.pdf No No Fillable Printable

Health Health Care Services

 

2,967,000 0
   
Individuals or Households
 
   0 %

  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 2,967,000 0 0 261,000 0 2,706,000
Annual IC Time Burden (Hours) 593,400 0 0 52,200 0 541,200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HHCAHPS_LeadLetter1_English HHCAHPS_LeadLetter1_English.pdf 01/24/2014
HHCAHPS_LeadLetter2_English HHCAHPS_LeadLetter2_English.pdf 01/24/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy