Preparing Patient Records

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1240 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10500 Preparing Patient Records Form
CMS-10500 Outpatient and Ambulatory Surgery OAS CAHPS Survey OAS CAHPS_OMB_Attachment_A_OAS CAHPS Survey-04-21-15.docx Form
OAS CAHPS Crosswalk of Changes to Survey-Letter-Intro.xlsx Crosswalk IC Document

Information Collection (IC) Details

IC Title:	Preparing Patient Records	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
Form	CMS-10500	Outpatient and Ambulatory Surgery OAS CAHPS Survey	OAS CAHPS_OMB_Attachment_A_OAS CAHPS Survey-04-21-15.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,463	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	9,463	9,463
Annual IC Time Burden (Hours)	321,742	321,742
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	OAS CAHPS Crosswalk of Changes to Survey-Letter-Intro.xlsx	05/06/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.