National Implementation

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

OMB: 0938-1240

IC ID: 216390

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

View Information Collection (IC)

National Implementation
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10500 OAS CAHPS (Mail Survey) OAS CAHPS Attachment A-Mail Questionnaire.pdf No   Fillable Fileable
Form and Instruction CMS-10500 OAS CAHPS (Telephone Script) OAS CAHPS Attachment B-CATI Questionnaire.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10500 OAS CAHPS (Web Survey Screenshots) OAS CAHPS Attachment C-Web Questionnaire.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10500 OAS CAHPS - Spanish Attachment E1 - OAS CAHPS - Spanish Survey.pdf No   Fillable Fileable
Form and Instruction CMS-10500 OAS CAHPS - ChineseSimplified Attachment E2 - OAS CAHPS - ChineseSimplified.pdf No   Fillable Fileable
Form and Instruction CMS-10500 OAS CAHPS - ChineseTraditional Attachment E3 - OAS CAHPS - ChineseTraditional.pdf No   Fillable Fileable
Form and Instruction CMS-10500 OAS CAHPS - Korean Attachment E4 - OAS CAHPS - Korean.pdf No   Fillable Fileable
Form and Instruction CMS-10500 OAS CAHPS - Russian Attachment E5 - OAS CAHPS - Russian.pdf No   Fillable Fileable

Health Health Care Services

 

2,524,400 0
   
Individuals or Households
 
   0 %

  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 2,524,400 0 0 1,534,400 0 990,000
Annual IC Time Burden (Hours) 328,172 0 0 199,472 0 128,700
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letters OAS CAHPS Attachment D1-Mail Cover Letters.pdf 02/23/2024
Letter Invitation for Web Survey OAS CAHPS Attachment D2-Initial Web Survey Invitation Letter.pdf 02/23/2024
Initial Web Survey Invitation Email OAS CAHPS Attachment D3-Initial Web Survey Invitation Email.pdf 02/23/2024
Follow up Web Survey Invitation Letter OAS CAHPS Attachment D4-Followup Web Survey Invitation Letter.pdf 02/23/2024
Follow up Web Survey Invitation Email OAS CAHPS Attachment D5-Followup Web Survey Invitation Email.pdf 02/23/2024
Web with Mail Followup_Questionnaire Cover Letter OAS CAHPS Attachment D6-Web with Mail Followup_Questionnaire Cover Letter.pdf 02/23/2024
Prenote Letter for Telephone Only OAS CAHPS Attachment D7-Prenote Letter for Telephone Only.pdf 02/23/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
© 2024 OMB.report | Privacy Policy