Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) Survey Database

Forms and Documents

Document Name	Status
Form 4 Attachment E: Submission Emails Form and Instruction	Modified
Form 3 Attachment D: Hospital Information Submission Form Form and Instruction	Modified
Form 2 Attachment B: Child HCAHPS Database Data Use Agreement Form and Instruction	Modified
Form 1 Attachment A: Child HCAHPS Registration Form Form and Instruction	Modified
Attachment E Submission Emails.pdf Supplementary Document	2026-01-16
Child HCAHPS Database_OMB Statement B 1 16 26.docx Supporting Statement B	2026-01-16
Child HCAHPS Database_OMB Statement A_1-15-26 clean.docx Supporting Statement A	2026-01-16

IC Document Collections

IC ID	Document Title	Status
235459	Attachment E: Submission Emails Form and Instruction	Modified
235458	Attachment D: Hospital Information Submission Form Form and Instruction	Modified
235457	Attachment B: Child HCAHPS Database Data Use Agreement Form and Instruction	Modified
235456	Attachment A: Child HCAHPS Registration Form Form and Instruction	Modified

ICR Details

OMB Control No: 0935-0243	ICR Reference No: 202601-0935-001
Status: Received in OIRA	Previous ICR Reference No: 202209-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) Survey Database
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/21/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	200	0
Time Burden (Hours)	61	0
Cost Burden (Dollars)	6,801	0

---

Abstract: The Child HCAHPS survey assesses the experiences of pediatric patients (less than 18 years old) and their parents or guardians with inpatient care. It complements the CAHPS Adult Hospital Survey (HCAHPS), which asks adult inpatients about their experiences. The Child HCAHPS Database is a voluntary database available to all Child HCAHPS users to support both quality improvement and research to enhance the patient-centeredness of care delivered to pediatric hospital patients. Like the survey instrument itself and related toolkit materials to support survey implementation, aggregated Child HCAHPS Database results will be made publicly available on AHRQ’s CAHPS website. Technical assistance will be provided by AHRQ through its contractor at no charge to hospitals to facilitate the access and use of these materials for quality improvement and research. Technical assistance is also provided to support Child HCAHPS data submission. This research seeks to answer the following questions: 1) What are the key drivers of patient experience in pediatric settings? 2) How do pediatric patients experience of care vary across the West, Midwest, South, and North East regions? 3) What are the highest and lowest scoring measures in specific areas of care for pediatric hospitals? The Child HCAHPS Database supports AHRQ’s goals of promoting improvements in the quality and patient-centeredness of health care in pediatric hospital settings. This research has the following goals: 1. Improve care provided by individual hospitals and hospital systems. 2. Offer several products and services, including providing survey results presented through summary chartbooks, custom analyses, private reports and data for research purposes. 3. Provides information to help identify strengths and areas with potential for improvement in patient care.

---

Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Agency for Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 46290	09/25/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 58564	12/17/2025
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Attachment A: Child HCAHPS Registration Form	1	Attachment A- Child CAHPS Registration form
Attachment B: Child HCAHPS Database Data Use Agreement	2	Attachment B- Child CAHPS Database DUA
Attachment D: Hospital Information Submission Form	3	Attachment D- Hospital Information Submission Form
Attachment E: Submission Emails	4	Attachment E: Submission Emails

---

ICR Summary of Burden

	Total Request	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	200	0	0	0	-1,000	1,200
Annual Time Burden (Hours)	61	0	0	0	-304	365
Annual Cost Burden (Dollars)	6,801	0	0	1,288	5,513	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $276,016

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/21/2026

---