OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Hospital National Provider Survey

IC 217140 under ICR 201506-0938-008 · OMB 0938-1290.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Hospital National Provider Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10550 Qualitative Interview Guide Hospital Attachment III Qualitative Interview Guide Mapping Research Question to Interview Question 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10550 Structured Research Question Mapped to Survey Questions Hospital Attachment IV Structured Survey Questions Mapped to Research Questions 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10550 Summary of Interview Hospital Attachment VI Summary of Interview Content 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10550 List of Quality and Efficiency Measures Hospital Attachment VII List of Quality and Efficiency Measures 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10550 Interview Topic Guide for Semi-Structured Interview Hospital Attachment VIII Interview Topic Guide for Semi-Structured Interview 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10550 Standardized Hospital National Provider Survey Hospital Attachment XIII Standardized Hospital National Provider Survey 2015 11 10.docx Yes Yes Fillable Fileable

Health Health Care Services

 

940 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   30 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 940 0 940 0 0 0
Annual IC Time Burden (Hours) 639 0 639 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
List of Attachments Hospital National Provider Survey List of Attachments 2015 11 10.docx 11/16/2015
Web Survery Invitation Email Hospital Attachment IX Web Survey Invitation Email 2015 11 10.docx 11/16/2015
Attachment V - Recruitment email Hospital Attachment V Recruitment email or letter 2015 11 10.docx 11/16/2015
Attachment X - First Mail Survey Letter Hospital Attachment X First Mail Survey Letter 2015 11 10.docx 11/16/2015
Attachment XI - Reminder Letter Hospital Attachment XI Reminder Letter 2015 11 10.docx 11/16/2015
Attqachment XII - Second Survey Cover Letter Hospital Attachment XII Second Survey Cover Letter 2015 11 10.docx 11/16/2015
Attachment I - Development of Two National Provider Surveys Hospital Attachment I Development of Two National Provider Surverys 2015 11 10.docx 11/16/2015
Attachment II - Data Sources Used for 2015 Impact Assessment Hospital Attachment II Data Sources Used for 2015 Impact Assessment Report 2015 11 10.docx 11/16/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.