National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey (CMS-10500)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10500 OAS CAHPS - Russian	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS - Korean	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS - ChineseTraditional	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS - ChineseSimplified.	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS - Spanish	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS (Web Survey Screenshots)	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS (Telephone Script)	Form	Modified	Available
Form CMS-10500 OAS CAHPS (Mail Survey)	Form and Instruction	Modified	Available
Form CMS-10500 HOPDs/ASCs Patient Records	Form and Instruction	Modified	Repair queued
Form CMS-10500 OAS CAHPS - Russian	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS - Korean	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS - ChineseTraditional	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS - ChineseSimplified	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS - Spanish	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS (Web Survey Screenshots)	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS (Telephone Script)	Form and Instruction	Modified	Available
Form CMS-10500 OAS CAHPS (Mail Survey)	Form	Modified	Available
Form CMS-10500 National Implementation	Form	Modified	Repair queued
CMS-10500-SupportingStatement-A.docx	Supporting Statement A	Uploaded 2024-02-27	Repair queued
CMS-10500-SupportingStatement-B.docx	Supporting Statement B	Uploaded 2024-02-23	Repair queued
Attachment G - Response to Comments.pdf	Supplementary Document	Uploaded 2024-02-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216391	HOPDs/ASCs Patient Records	Form and Instruction	Modified	OAS CAHPS - Russian
216391	HOPDs/ASCs Patient Records	Form and Instruction	Modified	OAS CAHPS - Korean
216391	HOPDs/ASCs Patient Records	Form and Instruction	Modified	OAS CAHPS - ChineseTraditional
216391	HOPDs/ASCs Patient Records	Form and Instruction	Modified	OAS CAHPS - ChineseSimplified.
216391	HOPDs/ASCs Patient Records	Form and Instruction	Modified	OAS CAHPS - Spanish
216391	HOPDs/ASCs Patient Records	Form and Instruction	Modified	OAS CAHPS (Web Survey Screenshots)
216391	HOPDs/ASCs Patient Records	Form	Modified	OAS CAHPS (Telephone Script)
216391	HOPDs/ASCs Patient Records	Form and Instruction	Modified	OAS CAHPS (Mail Survey)
216391	HOPDs/ASCs Patient Records	Form and Instruction	Modified
216390	National Implementation	Form and Instruction	Modified	OAS CAHPS - Russian
216390	National Implementation	Form and Instruction	Modified	OAS CAHPS - Korean
216390	National Implementation	Form and Instruction	Modified	OAS CAHPS - ChineseTraditional
216390	National Implementation	Form and Instruction	Modified	OAS CAHPS - ChineseSimplified
216390	National Implementation	Form and Instruction	Modified	OAS CAHPS - Spanish
216390	National Implementation	Form and Instruction	Modified	OAS CAHPS (Web Survey Screenshots)
216390	National Implementation	Form and Instruction	Modified	OAS CAHPS (Telephone Script)
216390	National Implementation	Form	Modified	OAS CAHPS (Mail Survey)
216390	National Implementation	Form	Modified

ICR Details

OMB Control No: 0938-1240	ICR Reference No: 202402-0938-009
Status: Active	Previous ICR Reference No: 202107-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey (CMS-10500)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/24/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/27/2024
Terms of Clearance: Approved consistent with the understanding that in the next revision/extension of the package, the agency will update the race/ethnicity question in this information collection to be in compliance with the updated SPD 15 (effective as of March 28, 2024).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	36 Months From Approved	11/30/2024
Responses	2,534,643	0	993,300
Time Burden (Hours)	614,976	0	221,100
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected in the national implementation of OAS CAHPS will be used for the following purposes: -To provide a source of information from which selected measures can be publicly reported to beneficiaries to help them make informed decisions for outpatient surgery facility selection; -To aid facilities with their internal quality improvement efforts and external benchmarking with other facilities; and -To provide CMS with information for monitoring and public reporting purposes. For the mode experiment, CMS plans to use information from this mode experiment to determine whether additional mode of administration (i.e. Web data collection) should be included in the current national implementation of OAS CAHPS protocols.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 931 Name of Law: Quality Measure Development, Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 83946	12/01/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 14078	02/26/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
HOPDs/ASCs Patient Records	CMS-10500, CMS-10500, CMS-10500, CMS-10500, CMS-10500, CMS-10500, CMS-10500, CMS-10500	OAS CAHPS (Mail Survey) ,   OAS CAHPS (Telephone Script) ,   OAS CAHPS (Web Survey Screenshots) ,   OAS CAHPS - Spanish ,   OAS CAHPS - ChineseSimplified. ,   OAS CAHPS - ChineseTraditional ,   OAS CAHPS - Korean ,   OAS CAHPS - Russian
National Implementation	CMS-10500, CMS-10500, CMS-10500, CMS-10500, CMS-10500, CMS-10500, CMS-10500, CMS-10500	OAS CAHPS (Mail Survey) ,   OAS CAHPS (Telephone Script) ,   OAS CAHPS (Web Survey Screenshots) ,   OAS CAHPS - Spanish ,   OAS CAHPS - ChineseSimplified ,   OAS CAHPS - ChineseTraditional ,   OAS CAHPS - Korean ,   OAS CAHPS - Russian

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,534,643	993,300	0	0	1,541,343	0
Annual Time Burden (Hours)	614,976	221,100	0	0	393,876	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The total number of HOPDs and ASCs that are expected to participate has increased over time. The current burden tables reflect the increase in participation rates and has resulted in an increase in the annual hourly burden.

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Annual Cost to Federal Government: $1,720,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/27/2024

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