Data Files Submission

Consumer Assessment of Healthcare Providers and Systems (CAHPS®)Home and Community Based Services (HCBS) Survey Database

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0245 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Data Files Submission Form and Instruction
4 Data Files Submission Attachment E Data Submission Emails_FINAL_11.26 .docx Form and Instruction
60 Day FRN.pdf 60 Day Federal Register Notice IC Document

Information Collection (IC) Details

IC Title:	Data Files Submission	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	Data Files Submission	Attachment E Data Submission Emails_FINAL_11.26 .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	52	52
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
60 Day Federal Register Notice	60 Day FRN.pdf	07/23/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.