OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Technical Assistance (TA) User Feedback for Program and User Support and Quality Measure Tool Development for Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Surveys on Patient Sa

IC 231329 under ICR 202501-0935-001 · OMB 0935-0179.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 1
Technical Assistance (TA) User Feedback for Program and User Support and Quality Measure Tool Development for Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Surveys on Patient Sa		 Form and Instruction
Form 1
Questions for Users of SOPS Technical Assistance Technical Assistance (TA) User Feedback for Program and User Support and Quality Measure Tool Development for Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Surveys on Patient Sa		 Form and Instruction
Form 2
Questions for Users of CAHPS Technical Assistance Technical Assistance (TA) User Feedback for Program and User Support and Quality Measure Tool Development for Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Surveys on Patient Sa		 Form and Instruction
1 Questions for Users of SOPS Technical Assistance
SOPS TA User Feedback 4-17-2018.docx 		Form and Instruction
1 Questions for Users of SOPS Technical Assistance
SOPS TA User Feedback 4-17-2018.docx 		Form and Instruction
2 Questions for Users of CAHPS Technical Assistance
CAHPS TA User Feedback 4-17-2018.docx 		Form and Instruction
2 Questions for Users of CAHPS Technical Assistance
CAHPS TA User Feedback 4-17-2018.docx 		Form and Instruction
SOPS TA User Feedback 4-27-2018EB3.docx
Supporting Statement		IC Document
SOPS TA User Feedback 4-27-2018EB3.docx
Supporting Statement		IC Document
OMB Cover Letter.doc
Cover Letter		IC Document
OMB Cover Letter.doc
Cover Letter		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Yes Yes Fillable Fileable
Form and Instruction 2 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested 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 120 0 0 0 0 120
Annual IC Time Burden (Hours) 6 0 0 0 0 6
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Supporting Statement 05/04/2018
Cover Letter 05/04/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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