Use of Narrative Data to Explore Disparities in Patient Experience

Use of Open-Ended Responses to Explore Disparities in Patient Experience

Documents and Forms

Document Name Document Type
Form Form #1 Use of Narrative Data to Explore Disparities in Patient Experience Form and Instruction
Form #1 Survey Instrument Attachment B Survey Instrument 042523.docx Form and Instruction
Form #1 Survey Instrument Attachment B Survey Instrument 042523.docx Form and Instruction
Attachment A CG-CAHPS NEP Invitation 042523.docx CG-CAHPS NEP Invitation IC Document
Attachment A CG-CAHPS NEP Invitation 042523.docx CG-CAHPS NEP Invitation IC Document
Attachment C Informed Consent 042523.docx Informed Consent IC Document
Attachment C Informed Consent 042523.docx Informed Consent IC Document
Attachment D Ipsos Confidentiality Agreement 021023.docx Ipsos Confidentiality Agreement IC Document
Attachment D Ipsos Confidentiality Agreement 021023.docx Ipsos Confidentiality Agreement IC Document

Information Collection (IC) Details

IC Title:	Use of Narrative Data to Explore Disparities in Patient Experience	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #1	Survey Instrument	Attachment B Survey Instrument 042523.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,998	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,998	4,998
Annual IC Time Burden (Hours)	1,416	1,416
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CG-CAHPS NEP Invitation	Attachment A CG-CAHPS NEP Invitation 042523.docx	09/15/2023
Informed Consent	Attachment C Informed Consent 042523.docx	09/15/2023
Ipsos Confidentiality Agreement	Attachment D Ipsos Confidentiality Agreement 021023.docx	09/15/2023

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