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Federal forms, ICRs, and supporting documents

Information Collection

Gen-IC #1 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey Mode Experiment

IC 245297 under ICR 201904-0938-010 · OMB 0938-1370.

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

View Information Collection (IC)

Gen-IC #1 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey Mode Experiment
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10694 GenIC 1 CAHPS® Hospice Survey CAHPS Hospice Survey_QNR for testing_1-7-21.docx Yes Yes Fillable Printable

Health Health Care Services

 

12,000 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 12,000 0 12,000 0 0 0
Annual IC Time Burden (Hours) 1,956 0 1,956 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement GenIC#1 Generic Supporting Statement CAHPS Hospice Survey.docx 01/12/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.