Participation Exemption Request (PER) Form

CAHPS Home Health Care Survey (CMS-10275)

OMB: 0938-1066

IC ID: 210204

Information Collection (IC) Details

View Information Collection (IC)

Participation Exemption Request (PER) Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10275 Participation Exemption Request (PER) Form HHCAHPS_ParticipationExemptionRequest2021AnnualPaymentUpdate.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

700 0
   
Private Sector Not-for-profit institutions
 
   100 %

  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 700 0 0 -300 0 1,000
Annual IC Time Burden (Hours) 231 0 0 -99 0 330
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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