Information Collection Request

Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey

ICR 202206-3206-001 · OMB 3206-0274 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form OMB 3206-0274 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey Form and Instruction New Repair queued
Form 3206-XXXX Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey Form and Instruction Removed Repair queued
CAHPS Supporting Statement A 2022.docx Supporting Statement A Uploaded 2022-06-13 Missing upstream
Statement B 4-29-22.docx Supporting Statement B Uploaded 2022-06-13 Repair queued
30 Day Notice 3206 0274.pdf Supplementary Document Uploaded 2022-06-13 Repair queued
60 Day Notice 3206 2074.pdf Supplementary Document Uploaded 2022-06-13 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
254218 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey Form and Instruction New
237579 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey Form and Instruction Removed

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 12/31/2022
73,505 73,505
18,376 18,376
197,728 197,546





table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 73,505 73,505 0 73,505 -73,505 0
Annual Time Burden (Hours) 18,376 18,376 0 18,376 -18,376 0
Annual Cost Burden (Dollars) 197,728 197,546 0 197,728 -197,546 0


Reginfo record details
  No