HCAHPS Survey (Patients)

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

OMB: 0938-0981

IC ID: 8843

Information Collection (IC) Details

View Information Collection (IC)

HCAHPS Survey (Patients)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Telephone Script) CMS-10102 Telephone Script (English)11-21-18 .pdf No   Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (AVIR Script) CMS-10102 AIVR Script (English) 11-21-18.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) and Supporting Materials CMS-10102 Mail Survey Materials (English) 11-21-18.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

3,104,200 0
   
Individuals or Households
 
   0 %

  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 3,104,200 0 0 0 0 3,104,200
Annual IC Time Burden (Hours) 375,090 -38,700 0 0 0 413,790
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk CMS-10102 Crosswalk 11-27-18.xlsx 03/15/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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