OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Nursing Home National Provider Survey

IC 217141 under ICR 201506-0938-009 · OMB 0938-1291.

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)

Nursing Home 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-10551 Qualitative Interview Guide NH Attachment III NH Qualitative Interview Guide Mapping Research to Interview 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10551 Structured Research Guide NH Attachment IV NH Structured Research Questions Mapped to Survey Questions 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10551 Summary of Interview NH Attachment VI Summary of Interview Content 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10551 List of Quality and Efficiency Measures NH Attachment VII List of Quality Measures 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10551 Interview Topic Guide for Semi-Structured Interview NH Attachment VIII Interview Topic Guide for Semi-Structured Interview 2015 11 10.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10551 Standardized Hospital National Provider Survey NH Attachment XIII Standardized Nursing Home National Provider Survey 2015 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
Llst of Attachments Nursing Home National Provider Survey List of Attachments 2015 11 10.docx 11/16/2015
Second Survey Cover Letter NH Attachment XII Second Survey Cover Letter 2015 11 10.docx 11/16/2015
Attachment XI - Reminder Letter NH Attachment XI Reminder Letter 2015 11 10.docx 11/16/2015
Attachment X - First Mail Survey Letter NH Attachment X First Mail Survey Cover Letter 2015 11 10.docx 11/16/2015
Recruitment Email NH Attachment V Recruitment email or letter 2015 11 10.docx 11/16/2015
Attachment IX - Web Survey Invitation Emial NH Attachment IX Web Survey Invitation Email 2015 11 10.docx 11/16/2015
Attachment I - Development of Two National Provider Surveys NH Attachment I Development of Two National Provider Surverys 2015 11 10.docx 11/16/2015
Attachment II - Data Sources used for 2015 Impact Assessment NH 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.