Information Collection

HCAHPS Only

IC 215079 under ICR 201502-0938-005 · OMB 0938-1273.

Documents and Forms

Document Name Document Type
Attachment5_HCAHPS_Cover_Letter.pdf Other-Letters: Initial and Follow Up
CMS-10102 HCAHPS Only ARM, Mode Experiment Attachment1-HCAHPS.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HCAHPS Only	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Letters: Initial and Follow Up			Attachment5_HCAHPS_Cover_Letter.pdf		No		Paper Only
Form	CMS-10102	HCAHPS Only ARM, Mode Experiment	Attachment1-HCAHPS.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,467	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	1,467	1,467
Annual IC Time Burden (Hours)	195	195
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.