Information Collection

HHCAHPS Survey

IC 188901 under ICR 202507-0938-002 · OMB 0938-1066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1066 can be found here:

2025-12-02 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10275 HHCAHPS Survey	Form and Instruction
Form CMS-10275 CMS-10275. Attachment C_Proposed HHCAHPS Survey questionnaire (All Languages) HHCAHPS Survey	Form and Instruction
CMS-10275 CMS-10275. Attachment C_Proposed HHCAHPS Survey question CMS-10275. Attachment C_Proposed HHCAHPS Survey questionnaire (All Languages).pdf	Form and Instruction
CMS-10275 CMS-10275. Attachment C_Proposed HHCAHPS Survey question CMS-10275. Attachment C_Proposed HHCAHPS Survey questionnaire (All Languages).pdf	Form and Instruction
CMS-10275. Attachment D.1_1stEnglishSurveyCoverLetter.docx CMS-10275. Attachment D.1_1stEnglishSurveyCoverLetter	IC Document
CMS-10275. Attachment D.1_1stEnglishSurveyCoverLetter.docx CMS-10275. Attachment D.1_1stEnglishSurveyCoverLetter	IC Document
CMS-10275. Attachment D.2_2ndEnglishSurveyCoverLetter.docx CMS-10275. Attachment D.2_2ndEnglishSurveyCoverLetter	IC Document
CMS-10275. Attachment D.2_2ndEnglishSurveyCoverLetter.docx CMS-10275. Attachment D.2_2ndEnglishSurveyCoverLetter	IC Document
CMS-10275. Attachment D.4_StandardTelephoneScriptEnglishREDLINE.docx CMS-10275. Attachment D.4_StandardTelephoneScriptEnglishREDLINE	IC Document
CMS-10275. Attachment D.4_StandardTelephoneScriptEnglishREDLINE.docx CMS-10275. Attachment D.4_StandardTelephoneScriptEnglishREDLINE	IC Document
CMS-10275. Attachment D.3_ProxyTelephoneScriptEnglishREDLINE.docx CMS-10275. Attachment D.3_ProxyTelephoneScriptEnglishREDLINE	IC Document
CMS-10275. Attachment D.3_ProxyTelephoneScriptEnglishREDLINE.docx CMS-10275. Attachment D.3_ProxyTelephoneScriptEnglishREDLINE	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

HHCAHPS Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	CMS-10275				Yes	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,025,894

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,025,894	-17,553	1,043,447
Annual IC Time Burden (Hours)	153,884	-54,805	208,689
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10275. Attachment D.1_1stEnglishSurveyCoverLetter		07/02/2025
CMS-10275. Attachment D.2_2ndEnglishSurveyCoverLetter		07/02/2025
CMS-10275. Attachment D.4_StandardTelephoneScriptEnglishREDLINE		07/02/2025
CMS-10275. Attachment D.3_ProxyTelephoneScriptEnglishREDLINE		07/02/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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