National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102)

Forms and Documents

Document Name	Status
Form CMS-10102 HCAHPS Survey (Patients) Form and Instruction	Modified
Form CMS-10102 HCAHPS Survey (Patients via Hospital Data Collection) Form and Instruction	Modified
CMS-10102 HCAHPS survey, Justification (Non-sub change 4-26-17).docx Justification for No Material/Nonsubstantive Change	2017-05-04
Attachment C - HCAHPS_Mode_Exp_III.doc Supplementary Document	2015-07-07
5-18-15 -- response to comment [rev 5-29-2015 by OSORA PRA].docx Supplementary Document	2015-05-29
DCAPP, 3-31-15 -- HCAHPS SUPPORTING STATEMENT B - 33015.pdf Supporting Statement B	2015-05-29
CMS-10102 - Supporting Statement A [rev 07-07-2015 by OSORA PRA].docx Supporting Statement A	2015-07-07

IC Document Collections

IC ID	Document Title	Status
8843	HCAHPS Survey (Patients) Form and Instruction	Modified
202110	HCAHPS Survey (Patients via Hospital Data Collection) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0981	ICR Reference No: 201705-0938-003
Status: Historical Active	Previous ICR Reference No: 201505-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/27/2017
	Date Received in OIRA: 05/10/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2018	07/31/2018	07/31/2018
Responses	3,104,200	0	3,104,200
Time Burden (Hours)	417,430	0	417,430
Cost Burden (Dollars)	35,675,000	0	35,675,000

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Abstract: The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals collect information on patient satisfaction, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals.

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Authorizing Statute(s): PL: Pub.L. 109 - 171 1886(b)(3)(B) Name of Law: Deficit Reduction Act of 2005
   PL: Pub.L. 111 - 148 3001 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 13391	03/13/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 30683	05/29/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
HCAHPS Survey (Patients)	CMS-10102	HCAHPS Survey Instrument (Mail) and Supporting Materials
HCAHPS Survey (Patients via Hospital Data Collection)	CMS-10102	HCAHPS Survey Instrument (Mail) and Supporting Materials

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,104,200	3,104,200	0	0	0	0
Annual Time Burden (Hours)	417,430	417,430	0	0	0	0
Annual Cost Burden (Dollars)	35,675,000	35,675,000	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: All changes in burden since our previous OMB package are due to an increase in the number of hospitals participating in the HCAHPS Survey. In 2012, 3,812 hospitals participated in HCAHPS. Over the next three years, we estimate that approximately 4,200 hospitals will participate in HCAHPS, an increase of about 388 hospitals (10.2%). The number of patient respondents has increased by 390,000 (2,710,000 in 2012 to 3,100,000).

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Annual Cost to Federal Government: $3,230,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/10/2017

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