Mode Experiment

National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey (CMS-10500)

OMB: 0938-1240

IC ID: 209906

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Mode Experiment
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10500 OAS CAHPS (Mail Survey) Attachment A - Mail Questionnaire [07-31-2018].docx No   Fillable Fileable
Form and Instruction CMS-10500 OAS CAHPS (Telephone Script) Attachment B - CATI Questionnaire [07-31-2018].docx Yes Yes Fillable Fileable
Form and Instruction CMS-10500 OAS CAHPS (Web Survey Screenshots) Attachment C - Web Questionnaire [07-31-2018].docx Yes Yes Fillable Fileable

Health Health Care Services

 

7,850 0
   
Individuals or Households
 
   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 -7,850 0 0 7,850
Annual IC Time Burden (Hours) 0 0 -1,021 0 0 1,021
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letters (Mail Mode) OAS CAHPS NI-ME Attachment D1-Cover_Letters - Mail Mode.docx 07/31/2018
Letter Invitation (Web Survey) First Contact OAS CAHPS ME Attachment D2-Letter Invitation for Web Survey_1st Contact.....docx 07/31/2018
E-mail Invitation (Web Survey) First Contact OAS CAHPS ME Attachment D3-Email Invitation for Web Survey_Reminder Cont....docx 07/31/2018
E-mail Invitation (Web Survey) Reminder OAS CAHPS ME Attachment D4-Email Invitation for Web Survey_Reminder Cont....docx 07/31/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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