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Federal forms, ICRs, and supporting documents

Information Collection

CAHPS for MIPS Survey Beneficiary Participation

IC 206234 under ICR 202401-0938-011 · OMB 0938-1222.

Documents and Forms
Document Name
Document Type
Form
Instruction
Instruction
Instruction
Instruction
Form
Form
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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CAHPS for MIPS Survey Beneficiary Participation
 
No Modified
 
Voluntary
 
42 CFR 414.1330 and 414.1335

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10450 Mail Survey Appendix-B1-2024-mail-survey.pdf Yes Yes Fillable Fileable
Instruction Appendix-C1-2024-survey-initial-cover-letter.pdf Yes Yes Fillable Fileable
Instruction Appendix-D1-2024-survey-second-cover-letter.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10450 CAHPS for MIPS CATI Script Appendix-E1-2024-CATI-script.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

25,500 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 25,500 0 -4,452 0 0 29,952
Annual IC Time Burden (Hours) 5,567 0 -973 0 0 6,540
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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