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Mode Experiment
National Implementation of the Hospice Experience of Care Survey (CAHPs Hospice Survey - CMS-10537)
OMB: 0938-1257
IC ID: 212900
OMB.report
HHS/CMS
OMB 0938-1257
ICR 202005-0938-014
IC 212900
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1257 can be found here:
2024-07-10 - Revision of a currently approved collection
2023-04-18 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Mode Experiment
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
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
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
18,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
0
0
-18,000
0
0
18,000
Annual IC Time Burden (Hours)
0
0
-3,150
0
0
3,150
Annual IC Cost Burden (Dollars)
0
0
0
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.