CAHPS for MIPS Survey Vendor Application

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for the Merit-Based Incentive Payment System (MIPS) (CMS-10450)

OMB: 0938-1222

IC ID: 227776

Information Collection (IC) Details

View Information Collection (IC)

CAHPS for MIPS Survey Vendor Application
 
No Unchanged
 
Voluntary
 
42 CFR 414.1400

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10450 Appendix F: Vendor Form Appendix F 2019-CAHPS-for-MIPS-Survey-Vendors-Application (rev OSORA PRA).docx Yes Yes Fillable Fileable
Form and Instruction CMS-10450 Appendix H: Vendor Attestation Appendix H CAHPS for MIPS Vendor Attestation Statement 12.04.17 (rev OSORA PRA).docx Yes Yes Fillable Fileable

Health Health Care Services

 

15 0
   
Individuals or Households
 
   100 %

  Requested 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 15 0 0 0 0 15
Annual IC Time Burden (Hours) 150 0 0 0 0 150
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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