Patient Files

CAHPS Home Health Care Survey (CMS-10275)

OMB: 0938-1066

IC ID: 195477

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Patient Files
 
No Modified
 
Voluntary
 
42 CFR 484.250

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction sampling from the patient administrative record info from the hha lists.doc No   Printable Only

Health Health Care Services

 

8,990 0
   
Private Sector Not-for-profit institutions
 
   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 107,880 0 0 -11,316 0 119,196
Annual IC Time Burden (Hours) 215,760 0 0 -22,632 0 238,392
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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