EDPEC Discharged to Community

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

Documents and Forms

Document Name Document Type
Attachment8-DischargedToCommunity-MixedLtr.pdf Other-Letter (Mailed)
Attachment9-DischargedToCommunity-OnsiteLtr.pdf Other-Letter (On-site Distribution)
CMS-10543 EDPEC Survey Telephone Script Attachment7-EDPEC PHONE SCRIPTS-ALL VERSIONS.pdf Form and Instruction
CMS-10543 EDPEC Discharged to Community Attachment4-EDPEC_Discharged to Community.pdf Form

Information Collection (IC) Details

IC Title:	EDPEC Discharged to Community	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	Available Electronically?	Electronic Capability
Other-Letter (Mailed)			Attachment8-DischargedToCommunity-MixedLtr.pdf	No	Paper Only
Other-Letter (On-site Distribution)			Attachment9-DischargedToCommunity-OnsiteLtr.pdf	No	Paper Only
Form and Instruction	CMS-10543	EDPEC Survey Telephone Script	Attachment7-EDPEC PHONE SCRIPTS-ALL VERSIONS.pdf	No	Fillable Printable
Form	CMS-10543	EDPEC Discharged to Community	Attachment4-EDPEC_Discharged to Community.pdf	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 576	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	576	576
Annual IC Time Burden (Hours)	103	103
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.