Information Collection Request

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

ICR 202509-0938-017 · OMB 0938-0926 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-10105 Medicare In-Center Hemodialysis Survey (Vietnamese) Form and Instruction Unchanged Repair queued
Form CMS-10105 Medicare In-Center Hemodialysis Survey (Traditional Chinese) Form and Instruction Unchanged Available
Form CMS-10105 Medicare In-Center Hemodialysis Survey (Simplified Chinese) Form and Instruction Unchanged Repair queued
Form CMS-10105 Medicare In-Center Hemodialysis Survey (Samoan) Form and Instruction Unchanged Repair queued
Form CMS-10105 Medicare In-Center Hemodialysis Survey (Spanish) Form and Instruction Unchanged Repair queued
Form CMS-10105 Medicare In-Center Hemodialysis Survey (English) Form and Instruction Unchanged Repair queued
CMS-10105_Supporting_Statement_part_B_ICH CAHPS_ 2025 clean.docx Supporting Statement B Uploaded 2025-11-26 Repair queued
CMS-10105_Supporting_Statement_part_B_ICH CAHPS_ 2025 clean.docx Supporting Statement B Uploaded 2025-11-26 Repair queued
CMS-10105_Supporting_Statement_part_A_ ICH CAHPS_2025 revised CLEAN 9.18.25.docx Supporting Statement A Uploaded 2025-11-25 Repair queued
CMS-10105_Supporting_Statement_part_A_ ICH CAHPS_2025 revised CLEAN 9.18.25.docx Supporting Statement A Uploaded 2025-11-25 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
207671 In-Center Hemodialysis CAHPS Survey: National Implementation Form and Instruction UnchangedMedicare In-Center Hemodialysis Survey (Vietnamese)
207671 In-Center Hemodialysis CAHPS Survey: National Implementation Form and Instruction UnchangedMedicare In-Center Hemodialysis Survey (Traditional Chinese)
207671 In-Center Hemodialysis CAHPS Survey: National Implementation Form and Instruction UnchangedMedicare In-Center Hemodialysis Survey (Simplified Chinese)
207671 In-Center Hemodialysis CAHPS Survey: National Implementation Form and Instruction UnchangedMedicare In-Center Hemodialysis Survey (Samoan)
207671 In-Center Hemodialysis CAHPS Survey: National Implementation Form and Instruction UnchangedMedicare In-Center Hemodialysis Survey (Spanish)
207671 In-Center Hemodialysis CAHPS Survey: National Implementation Form and Instruction UnchangedMedicare In-Center Hemodialysis Survey (English)
207671 In-Center Hemodialysis CAHPS Survey: National Implementation Other-Sample Cover Letter (English) Unchanged
ICR Details
0938-0926 202509-0938-017
Active 202507-0938-021
HHS/CMS CM-CPC
National Implementation of In-Center Hemodialysis CAHPS Survey (CMS-10105)
Revision of a currently approved collection   No
Regular
Approved with change 02/09/2026
Retrieve Notice of Action (NOA) 11/26/2025
  Inventory as of this Action Requested Previously Approved
02/28/2029 36 Months From Approved 02/28/2026
207,500 0 190,000
41,500 0 51,300
0 0 0

CMS designed the ICH CAHPS survey and measures to enable dialysis patients to make more informed decisions when choosing a dialysis facility, to aid facilities in their quality improvement efforts, and to help CMS monitor the performance of dialysis facilities. CMS publicly reports clinical quality measures and patient experience of care survey results for kidney dialysis centers on Care Compare on Medicare.gov. Public reporting of ICH CAHPS data is refreshed in April and October, with each refresh including a rolling average of the two most recent survey periods available. Both clinical and patient experience of care quality measures enable patients with end-stage renal disease (ESRD) to make informed decisions when choosing a dialysis facility. The ICH CAHPS survey fulfills a requirement of the ESRD Quality Incentive Program (QIP).

US Code: 42 USC 1881(h) Name of Law: Social Security Act
  
None

0938-AV52 Final or interim final rulemaking 90 FR 53068 11/24/2025

Yes

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 207,500 190,000 0 17,500 0 0
Annual Time Burden (Hours) 41,500 51,300 0 -9,800 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
Although the average number sampled has increased, the hour burden has decreased from 51,300 in the previous projection to 41,500 due to a reduction in the survey length. The survey has decreased from 16 minutes to 12 minutes. See section B.3. Methods to Maximize Response Rate for more information on the ICH CAHPS Survey response rate.

$1,498,000
Yes Part B of Supporting Statement
    No
    No
Yes
No
No
No
Stephan McKenzie 410 786-1943 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/26/2025