Information Collection

Attachment A: Child HCAHPS Registration Form

IC 235456 under ICR 202601-0935-001 · OMB 0935-0243.

Documents and Forms

Document Name Document Type
Form 1 Attachment A: Child HCAHPS Registration Form Form and Instruction
Form 1 Attachment A- Child CAHPS Registration form Attachment A: Child HCAHPS Registration Form Form and Instruction
1 Attachment A- Child CAHPS Registration form Attachment A Registration Form.pdf Form and Instruction
1 Attachment A- Child CAHPS Registration form Attachment A Registration Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment A: Child HCAHPS Registration Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Attachment A- Child CAHPS Registration form	Attachment A Registration Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	50	0	-250	300
Annual IC Time Burden (Hours)	4	0	-21	25
Annual IC Cost Burden (Dollars)	530	530	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].