Information Collection Request
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)Home and Community Based Services (HCBS) Survey Database
ICR 202211-0935-001 · OMB 0935-0245 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0935-0245 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 4 Data Files Submission |
Form and Instruction | Unchanged | Repair queued |
| Form 3 Data Use Agreement |
Form and Instruction | Unchanged | Repair queued |
| Form 2 Program Information Form |
Form and Instruction | Unchanged | Repair queued |
| Form 1 Adult HCBS Registration Form |
Form | Modified | Repair queued |
 HCBS Database_OMB Statement B_7.11.2022_Clean.docx |
Supporting Statement B | Uploaded 2022-11-15 | Repair queued |
| HCBS Database_OMB Statement A_7.11.2022_Clean 1115.docx |
Supporting Statement A | Uploaded 2022-11-15 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 237061 |  Data Files Submission |
Form and Instruction | Unchanged | |
| 237059 | Data Use Agreement |
Form and Instruction | Unchanged | |
| 237058 | Program Information Form |
Form and Instruction | Unchanged | |
| 236877 | Adult HCBS Registration Form |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/AHRQ |
| OMB Control No | 0935-0245 |
| Type of Information Collection | Reinstatement without change of a previously approved collection |
| Previous ICR Reference No | 201907-0935-001 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |