Information Collection

Medicare Fee-For-Service CAHPS Survey

IC 194257 under ICR 201505-0938-006 · OMB 0938-0732.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0732 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-246 Medicare Fee-For-Service CAHPS Survey	Form and Instruction
CMS-R-246 Medicare Fee-For-Service CAHPS Survey FFS Survey.pdf	Form and Instruction
FFS survey crosswalk.pdf Crosswalk - FFS Survey	IC Document

IC Title:

Medicare Fee-For-Service CAHPS Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 423.159 42 CFR 422.152(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-246	Medicare Fee-For-Service CAHPS Survey	FFS Survey.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act of 1974: HPMS # 09-70-4004

FR Citation: 63 FR 43187

Number of Respondents: 274,950

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	274,950	216,450	58,500
Annual IC Time Burden (Hours)	82,485	64,935	17,550
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk - FFS Survey	FFS survey crosswalk.pdf	06/03/2015

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