National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10102 HCAHPS Survey Instrument (Mail) - Spanish	Form and Instruction	Unchanged	Available
Form CMS-10102 HCAHPS Survey Instrument (Telephone Script)	Form and Instruction	Unchanged	Available
Form CMS-10102 HCAHPS Survey Instrument (Mail) and Supporting Materials	Form and Instruction	Unchanged	Available
Form CMS-10102 HCAHPS Survey (Patients)	Form and Instruction	Unchanged	Repair queued
Form CMS-10102 HCAHPS Survey Translation - Spanish	Form and Instruction	Unchanged	Available
Form CMS-10102 HCAHPS Survey Instrument (Telephone Script)	Form and Instruction	Unchanged	Available
Form CMS-10102 HCAHPS Survey Instrument (Mail) and Supporting Materials	Form and Instruction	Unchanged	Available
Form CMS-10102 HCAHPS Survey (Patients via Hospital Data Collection)	Form and Instruction	Unchanged	Repair queued
CMS-10102 SUPPORTING STATEMENT B - 03-07-24.docx	Supporting Statement B	Uploaded 2024-08-28	Available
CMS-10102 SUPPORTING STATEMENT B - 03-07-24.docx	Supporting Statement B	Uploaded 2024-08-28	Repair queued
CMS-10102 SUPPORTING STATEMENT A 11-12-2024-clean2.docx	Supporting Statement A	Uploaded 2024-11-12	Repair queued
CMS-10102 SUPPORTING STATEMENT A 8-27-24.docx	Supporting Statement A	Uploaded 2024-08-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8843	HCAHPS Survey (Patients)	Form and Instruction	Unchanged	HCAHPS Survey Instrument (Mail) - Spanish
8843	HCAHPS Survey (Patients)	Form and Instruction	Unchanged	HCAHPS Survey Instrument (Telephone Script)
8843	HCAHPS Survey (Patients)	Form and Instruction	Unchanged	HCAHPS Survey Instrument (Mail) and Supporting Materials
8843	HCAHPS Survey (Patients)	Form and Instruction	Unchanged
202110	HCAHPS Survey (Patients via Hospital Data Collection)	Form and Instruction	Unchanged	HCAHPS Survey Translation - Spanish
202110	HCAHPS Survey (Patients via Hospital Data Collection)	Form and Instruction	Unchanged	HCAHPS Survey Instrument (Telephone Script)
202110	HCAHPS Survey (Patients via Hospital Data Collection)	Form and Instruction	Unchanged	HCAHPS Survey Instrument (Mail) and Supporting Materials
202110	HCAHPS Survey (Patients via Hospital Data Collection)	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0938-0981	ICR Reference No: 202408-0938-037
Status: Active	Previous ICR Reference No: 202404-0938-026
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC IPPS
Title: National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/13/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/28/2024
Terms of Clearance: Approved consistent with the understanding that 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) by December 2027.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	36 Months From Approved	01/31/2025
Responses	2,327,551	0	2,304,450
Time Burden (Hours)	314,206	0	282,366
Cost Burden (Dollars)	0	0	0

---

Abstract: The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals collect information on patient satisfaction, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals.

---

Authorizing Statute(s): PL: Pub.L. 109 - 171 1886(b)(3)(B) Name of Law: Deficit Reduction Act of 2005
   PL: Pub.L. 111 - 148 3001 Name of Law: Affordable Care Act
   PL: Pub.L. 115 - 271 6104 Name of Law: SUPPORT Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV34	Final or interim final rulemaking	89 FR 68986	08/28/2024

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
HCAHPS Survey (Patients via Hospital Data Collection)	CMS-10102, CMS-10102, CMS-10102	HCAHPS Survey Instrument (Mail) and Supporting Materials ,   HCAHPS Survey Instrument (Telephone Script) ,   HCAHPS Survey Translation - Spanish
HCAHPS Survey (Patients)	CMS-10102, CMS-10102, CMS-10102	HCAHPS Survey Instrument (Mail) and Supporting Materials ,   HCAHPS Survey Instrument (Telephone Script) ,   HCAHPS Survey Instrument (Mail) - Spanish

---

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	2,327,551	2,304,450	0	23,101	0	0
Annual Time Burden (Hours)	314,206	282,366	0	31,840	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The change in burden from earlier OMB PRA packages is based upon the increase in survey questions (from 29 to 32) and the expected use of the new web-first modes of survey administration. Furthermore, we employ the post-tax median hourly wage rate ($24.04) to align with the Collection of Information Requirements section of the FY 2025 IPPS/LTCH PPS final rule, which is lower than the previous rate of $33.04. The burden hours increased from 277,916 to 314,206 hours.

---

Annual Cost to Federal Government: $3,977,921

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

---

Common Form ICR:  No

---

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: 08/28/2024

---