Information Collection

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Adults

IC 192585 under ICR 201402-3206-007 · OMB 3206-0253.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0253 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Adults	Form and Instruction
0 Consumer Assessment of Healthcare Providers and Systems CAHPS 4.0H Adult Commercial_Questionnaire.doc	Form and Instruction
CAHPS survey SSB.doc supporting statement B	IC Document

IC Title:

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Â Adults

Agency IC Tracking Number:

IC Status: Modified

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	0	Consumer Assessment of Healthcare Providers and Systems (CAHPS) Â¿ Adults	CAHPS 4.0H Adult Commercial_Questionnaire.doc		No		Paper Only

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 210,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	210,000	210,000
Annual IC Time Burden (Hours)	70,000	70,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
supporting statement B	CAHPS survey SSB.doc	02/26/2014

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