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Patient Assessment
CAHPS Home Health Care Survey
OMB: 0938-1066
IC ID: 195477
OMB.report
HHS/CMS
OMB 0938-1066
ICR 201401-0938-015
IC 195477
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1066 can be found here:
2023-03-31 - Extension without change of a currently approved collection
2020-05-14 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Patient Assessment
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR 484.250
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
9,890
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
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
9,890
0
0
0
0
9,890
Annual IC Time Burden (Hours)
158,240
0
0
0
0
158,240
Annual IC Cost Burden (Dollars)
0
0
0
-39,560,000
0
39,560,000
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.