OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

HCAHPS Survey (Patients via Hospital Data Collection)

IC 202110 under ICR 202408-0938-037 · OMB 0938-0981.

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
Information Collection (IC) Details

View Information Collection (IC)

HCAHPS Survey (Patients via Hospital Data Collection)
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) and Supporting Materials Attachment A -- HCAHPS Survey Instrument - English -508.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Telephone Script) Attachment C -- HCAHPS CATI Script - English.pdf No   Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Translation - Spanish Attachment B -- HCAHPS Survey Instrument - Spanish - 508.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

4,461 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 4,461 0 11 0 0 4,450
Annual IC Time Burden (Hours) 4,461 0 11 0 0 4,450
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.