Form #3 Health Plan Submission

Collection of Information for Agency for Healthcare Research and Qualitys (AHRQ) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey Comparative Database

Attachment D -- Health Plan Information Form

OMB: 0935-0165

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This survey is authorized under 42 U.S.C. 299a. The confidentiality of your responses to this survey is protected by
Sections 944(c) and 308(d) of the Public Health Service Act [42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)].
Information that could identify you will not be disclosed unless you have consented to that disclosure.


File Typeapplication/pdf
AuthorTeresa Dodson
File Modified2019-10-25
File Created2019-10-25

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