Crosswalk

Attachment A. Crosswalk of Changes

This attachment crosswalks HOS Questionnaire changes since the last OMB clearance to the HOS Questionnaire submitted for this clearance.

2021 Survey Question			Proposed 2025 Survey Question	Type of Change	Reason for Change
11. Because of a health or physical problem, do you have any difficulty doing the following activities? Preparing meals No, I do not have difficulty Yes, I have difficulty I don’t do this activity Managing money No, I do not have difficulty Yes, I have difficulty I don’t do this activity Taking medication as prescribed No, I do not have difficulty Yes, I have difficulty			N/A	Removal	Removing this item because it is no longer being considered as a quality measure for Star Ratings and to reduce the number of questions on the survey. Item is not used in Star Ratings or other programs.
3		I don’t do this activity
These next questions ask about your physical and mental health during the past 30 days. 12. Now, thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? Please enter a number between "0" and "30" days. If no days, please enter “0” days. Your best estimate would be fine. days			N/A	Removal	Removing because this item is challenging for some older adults to complete and to reduce the number of questions on the survey. Item is not used in Star Ratings or other programs.

2021 Survey Question				Proposed 2025 Survey Question	Type of Change	Reason for Change
13. Now, thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? Please enter a number between "0" and "30" days. If no days, please enter “0” days. Your best estimate would be fine.					Removal	Removing because this item is challenging for some older adults to complete and to reduce the number of questions on the survey. Item is not used in Star Ratings or other programs.
			days
14. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation? Please enter a number between "0" and "30" days. If no days, please enter “0” days. Your best estimate would be fine.					Removal	Removing because this item is challenging for some older adults to complete and to reduce the number of questions on the survey. Item is not used in Star Ratings or other programs.
			days
38. In the past 7 days, how would you rate your pain on average? No pain 1 2 3 4 5 6 7 8 9 09 10 Worst imaginable pain 10				N/A	Removal	Removing this item given other work in this area to measure pain and the need to limit the number of survey questions. Item is not used in Star Ratings or other programs.
2021 Survey Question				Proposed 2025 Survey Question	Type of Change	Reason for Change
**Inclusion of Attachments E and F, Mailing Materials				N/A	N/A	Mailing Materials no longer being included in PRA packages for the division

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