Information Collection

National Implementation

IC 212899 under ICR 201408-0938-015 · OMB 0938-1257.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1257 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10537 National Implementation Form and Instruction
CMS-10537 Hospice Experience of Care Survey 508_Apppendix_A_Hospice Experience of Care Survey 2014_4_11.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Implementation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 418

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10537	Hospice Experience of Care Survey	508_Apppendix_A_Hospice Experience of Care Survey 2014_4_11.pdf		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 543,026	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	543,026	543,026
Annual IC Time Burden (Hours)	95,029	95,029
Annual IC Cost Burden (Dollars)	0	0

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.