Information Collection

Patient Files

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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					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 %

table that charts list of burden
	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

table that charts IC Documents
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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