CAHPS Home Health Care Survey (CMS-10275)

ICR 202512-0938-004

OMB: 0938-1066

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10275 Participation Exemption Request (PER) Form Form and Instruction	Modified
Form CMS-10275 HHCAHPS Survey Form and Instruction	Modified
2. CMS-10275. Supporting Statement B_HHCAHPS(final rule).docx Supporting Statement B	2025-12-02
1. CMS-10275. Supporting Statement A_HHCAHPS(final rule).docx Supporting Statement A	2025-12-02
4. Attachment B_Comparison of Current and Revised HHCAHPS Survey Instruments_06182025.pdf Supplementary Document	2025-12-02
3. Attachment A_Table of Updates to PRA Package Materials_06182025.pdf Supplementary Document	2025-12-02

IC Document Collections

IC ID	Document Title	Status
210204	Participation Exemption Request (PER) Form Form and Instruction	Modified
195477	Patient Files Instruction	Modified
188901	HHCAHPS Survey Form and Instruction	Modified