National Implementation

National Implementation of the Hospice Experience of Care Survey (CAHPs Hospice Survey - CMS-10537)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1257 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10537 National Implementation Form and Instruction
CMS-10537 Hospice Experience of Care Survey - Mail Attachment_A_Questionnaire_and_SampleLetter.pdf Form and Instruction
CMS-10537 CAHPS Hospice Survey - Telephone CMS-10537 - Appendix cahps-hospice-telephone_QNR_2017.pdf Form

Information Collection (IC) Details

IC Title:	National Implementation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 418

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10537	Hospice Experience of Care Survey - Mail	Attachment_A_Questionnaire_and_SampleLetter.pdf		No		Printable Only
Form	CMS-10537	CAHPS Hospice Survey - Telephone	CMS-10537 - Appendix cahps-hospice-telephone_QNR_2017.pdf		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,032,004	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,032,004	80,522	951,482
Annual IC Time Burden (Hours)	180,004	13,496	166,508
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.