Information Collection Request
CAHPS Home Health Care Survey (CMS-10275)
ICR 202303-0938-010 · OMB 0938-1066 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1066 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10275 Participation Exemption Request (PER) Form |
Form | Modified | Missing upstream |
| Form CMS-10275 HHCAHPS Survey |
Form | Modified | Missing upstream |
 CMS-10275 - HHCAHPS Supporting Statement A final.docx |
Supporting Statement A | Uploaded 2023-03-31 | Available |
 Attachment C_HHCAHPS_Survey_Q31_Response_Options_Crosswalk 12-29-2022.pdf |
Supplementary Document | Uploaded 2023-03-27 | Repair queued |
| CMS-10275 - HHCAHPS Supporting Statement B.docx |
Supporting Statement B | Uploaded 2023-03-27 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 210204 |  Participation Exemption Request (PER) Form |
Form | Modified | |
| 195477 | Patient Files |
Instruction | Modified | |
| 188901 | HHCAHPS Survey |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1066 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202005-0938-007 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |