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HCAHPS Survey (Patients via Hospital Data Collection)
National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102)
OMB: 0938-0981
IC ID: 202110
OMB.report
HHS/CMS
OMB 0938-0981
ICR 202408-0938-037
IC 202110
( )
Documents and Forms
Document Name
Document Type
Form CMS-10102
HCAHPS Survey (Patients via Hospital Data Collection)
Form and Instruction
CMS-10102 HCAHPS Survey Instrument (Mail) and Supporting Materials
Attachment A -- HCAHPS Survey Instrument - English -508.pdf
Form and Instruction
CMS-10102 HCAHPS Survey Instrument (Telephone Script)
Attachment C -- HCAHPS CATI Script - English.pdf
Form and Instruction
CMS-10102 HCAHPS Survey Translation - Spanish
Attachment B -- HCAHPS Survey Instrument - Spanish - 508.pdf
Form and Instruction
Information Collection (IC) Details
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