Information Collection

Patient Files

IC 195477 under ICR 202512-0938-004 · OMB 0938-1066.

Documents and Forms

Document Name Document Type
10. CMS-10275. Attachment E_Chapter 4 of the HHCAHPS Protocols & Guidelines Manual_CLEAN (final rule).pdf Instruction
10. CMS-10275. Attachment E_Chapter 4 of the HHCAHPS Protocols & Guidelines Manual_CLEAN (final rule).pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Patient Files	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 484.250

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			10. CMS-10275. Attachment E_Chapter 4 of the HHCAHPS Protocols & Guidelines Manual_CLEAN (final rule).pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,221	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	98,652	-7,176	105,828
Annual IC Time Burden (Hours)	197,304	-14,352	211,656
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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