Information Collection Request

Emergency Department Patient Experience of Care (EDPEC) Survey Mode Experiments (CMS-10543)

ICR 201502-0938-005 · OMB 0938-1273 · Historical Active

Forms and Documents

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
215083 EDPEC Discharged to Community Form NewEDPEC Discharged to Community
215083 EDPEC Discharged to Community Form and Instruction NewEDPEC Survey Telephone Script
215083 EDPEC Discharged to Community Other-Letter (Mailed) New
215081 EDPEC for Admitted Patients: HCAHPS Add-on Version B Form and Instruction NewEDPEC Survey Telephone Script
215081 EDPEC for Admitted Patients: HCAHPS Add-on Version B Form NewEDPEC for Admitted Patients: HCAHPS Add-on Version B
215081 EDPEC for Admitted Patients: HCAHPS Add-on Version B Other-Cover Letter New
215080 EDPEC for Admitted Patients: HCAHPS Add-on Version A Form and Instruction NewEDPEC Survey Telephone Script
215080 EDPEC for Admitted Patients: HCAHPS Add-on Version A Form NewEDPEC for Admitted Patients: HCAHPS Add-on Version A
215080 EDPEC for Admitted Patients: HCAHPS Add-on Version A Other-Cover Letter New
215079 HCAHPS Only Form NewHCAHPS Only ARM, Mode Experiment
215079 HCAHPS Only Other-Letters: Initial and Follow Up New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2018 36 Months From Approved
4,951 0 0
922 0 0
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
EDPEC Discharged to Community CMS-10543, CMS-10543 ,  
EDPEC for Admitted Patients: HCAHPS Add-on Version A CMS-10543, CMS-10543 ,  
EDPEC for Admitted Patients: HCAHPS Add-on Version B CMS-10543, CMS-10543 ,  
HCAHPS Only CMS-10102

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,951 0 0 4,951 0 0
Annual Time Burden (Hours) 922 0 0 922 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No