Information Collection Request
CAHPS Hospice Survey CMS-10537)
ICR 202304-0938-011 · OMB 0938-1257 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1257 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10537 National Implementation |
Form and Instruction | Modified | Repair queued |
 CMS-10537 Hospice Survey OMB_Statement_B _.docx |
Supporting Statement B | Uploaded 2023-04-17 | Repair queued |
| CMS-10537 Hospice Survey _Statement_A_.docx |
Supporting Statement A | Uploaded 2023-04-17 | Repair queued |
 Attachment_B_Case_Mix_Adjustment_Hospcie_CAHPS.pdf |
Supplementary Document | Uploaded 2020-07-01 | Repair queued |
| cahps-hospice-survey-quality-assurance-guideline-v6.0---september-2019.pdf |
Supplementary Document | Uploaded 2020-07-01 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 212899 |  National Implementation |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1257 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202005-0938-014 |
| Agency Tracking No | CPI |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |