Information Collection Request

Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) Survey (CMS-10500)

ICR 201505-0938-003 · OMB 0938-1240 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10500 Preparing Patient Records Form New Available
Form CMS-10500 National Implementation Form New Available
Form CMS-10500 Mode Experiment Form Modified Available
CMS-10500 - Supporting Statement A [rev 05-06-2015 by OSORA PRA].docx Supporting Statement A Uploaded 2015-05-06 Available
Response_to_60_Day_Notice_March 2015_Updated_4_23_15.docx Supplementary Document Uploaded 2015-05-04 Available
CMS-10500 - Supporting Statement B [rev 05-04-2015 by OSORA PRA].docx Supporting Statement B Uploaded 2015-05-04 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
216391 Preparing Patient Records Form New
216390 National Implementation Form New
209906 Mode Experiment Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2018 36 Months From Approved 06/30/2017
2,823,073 0 2,304
687,511 0 384
0 0 0





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 2,823,073 2,304 0 2,820,769 0 0
Annual Time Burden (Hours) 687,511 384 0 687,127 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No