Fee-For-Service (FFS) Survey

Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey (CMS-R-246)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0732 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-R-246 Fee-For-Service (FFS) Survey Form and Instruction
CMS-R-246 Fee-For-Service (FFS) Survey 2024-FFS-Survey.pdf Form and Instruction
CMS-R-246 Fee-For-Service (FFS) Survey 2024-FFS-Survey.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Fee-For-Service (FFS) Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 423.159 42 CFR 422.152(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-246	Fee-For-Service (FFS) Survey	2024-FFS-Survey.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Privacy Act of 1974: HPMS # 09-70-4004	FR Citation: 63 FR 43187

Number of Respondents: 275,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	275,000	50	274,950
Annual IC Time Burden (Hours)	68,750	12	68,738
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.