CAHPS for MIPS Survey

CAHPS Survey for the Merit-Based Incentive Payment System (MIPS) (CMS-10450)

OMB: 0938-1222

IC ID: 206234

Information Collection (IC) Details

View Information Collection (IC)

CAHPS for MIPS Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10450 CAHPS for MIPS Survey Script Appendix B- English CAHPS for MIPS Survey CATI Script_10282016.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10450 CAHPS for MIPS Survey Appendix A-English CAHPS for MIPS Survey_102816.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10450 CAHPS for MIPS Attestation Appendix E- CAHPS for MIPS Vendor Attestation Statement_102816.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

132,307 0
   
Individuals or Households
 
   100 %

  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 132,307 0 15,007 0 0 117,300
Annual IC Time Burden (Hours) 43,661 0 4,131 0 0 39,530
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Initial Cover Letter Appendix C- CAHPS for MIPS Initial Cover Letter_102816.docx 11/01/2016
Second Cover Letter Appendix D- CAHPS for MIPS Second Cover Letter_102816.docx 11/01/2016
Crosswalk CAHPS_Survey_Crosswalk_9.13.16.doc 11/01/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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