In-Center Hemodialysis CAHPS Survey: National Implementation

National Implementation of In-Center Hemodialysis CAHPS Survey (CMS-10105)

Documents and Forms

Document Name Document Type
ICH-CL1-Eng-Nov2024-OMBRevised.docx Other-Sample Cover Letter (English)
ICH-CL2-Eng-Nov2024-OMBRevised.docx Other-Sample Cover Letter (English)
CMS-10105 Medicare In-Center Hemodialysis Survey (English) ICH-SurveyStandardEnglish2024OMB-508.docx Form and Instruction
ICH-CL1-Span-Nov2024-OMBRevised.docx Other-Sample Cover Letter (Spanish
ICH-CL2-Span-Nov2024-OMBRevised.docx Other-Sample Cover Letter (Spanish
CMS-10105 Medicare In-Center Hemodialysis Survey (Spanish) ICH-SurveyStandardSpanish2024OMB-508.docx Form and Instruction
ICH _CL1_Sam_Nov2024_OMBRevised.docx Other-Other: Sample Cover Letter (Samoan)
CMS-10105 Medicare In-Center Hemodialysis Survey (Samoan) ICH-SurveyStandardSamoan2024OMB-508.docx Form and Instruction
ICH_CL1_SimChin_Nov2024_OMBRevised.docx Other-Other: Other: Sample Cover Letter (Simple Chinese
CMS-10105 Medicare In-Center Hemodialysis Survey (Simplified Chinese) ICH-SurveyStandardSimplifiedChinese2024OMB-508.docx Form and Instruction
ICH_CL1_TradChinese_Nov2024_OMBRevised.docx Other-Other: Sample Cover Letter (Traditional Chinese)
CMS-10105 Medicare In-Center Hemodialysis Survey (Traditional Chinese) ICH-SurveyStandardTraditionalChinese2024OMB-508.docx Form and Instruction
ICH-SurveyStandardVietnamese2024OMB-508.pdf.docx Other-Other: Other: Sample Cover Letter (Vietnamese)
CMS-10105 Medicare In-Center Hemodialysis Survey (Vietnamese) ICH-SurveyStandardVietnamese2024OMB-508.pdf.docx Form and Instruction

Information Collection (IC) Details