National Implementation

CAHPS Hospice Survey CMS-10537)

OMB: 0938-1257

IC ID: 212899

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

View Information Collection (IC)

National Implementation
 
No Modified
 
Voluntary
 
42 CFR 418

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10537 Hospice Experience of Care Survey - CAHPS Hospice Survey_English_.docx No   Fillable Printable
Form and Instruction CMS-10537 CAHPS Hospice Survey_Korean_ CAHPS Hospice Survey_Korean_06242024_.docx No   Fillable Printable
Form and Instruction CMS-10537 CAHPS Hospice Survey_Polish CAHPS Hospice Survey_Polish 06212024_.docx No   Fillable Printable
Form and Instruction CMS-10537 CAHPS Hospice Survey_Portuguese_ CAHPS Hospice Survey_Portuguese_06202024_.docx No   Fillable Printable
Form and Instruction CMS-10537 CAHPS Hospice Survey_Russian_ CAHPS Hospice Survey_Russian_06252024_.docx No   Fillable Printable
Form and Instruction CMS-10537 CAHPS Hospice Survey_Simplified Chinese_ CAHPS Hospice Survey_Simplified Chinese_06202024_.docx No   Fillable Printable
Form and Instruction CMS-10537 CAHPS Hospice Survey_Spanish_ CAHPS Hospice Survey_Spanish_06202024_.docx No   Fillable Printable
Form and Instruction CMS-10537 CAHPS Hospice_Vietnamese Survey_ CAHPS Hospice_Vietnamese Survey_06202024_.docx No   Fillable Printable
Form and Instruction CMS-10537 CAHPS Hospice Survey_Traditional Chinese CAHPS Hospice Survey_Traditional Chinese_.docx No   Fillable Printable

Health Health Care Services

 

1,159,420 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 1,159,420 0 0 18,725 0 1,140,695
Annual IC Time Burden (Hours) 168,116 0 0 -30,365 0 198,481
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CAHPS Hospice Survey_Track Change version Revised Survey Tracked with Changes from CAHPS Hospice QAG V10.0.2024_3_21.docx 07/10/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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