The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals collect information on patient satisfaction, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals.
The latest form for National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102) expires 2021-11-30 and can be found here.
Document Name |
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Form and Instruction |
Form and Instruction |
Supporting Statement A |
Supporting Statement B |
Supplementary Document |
Approved without change |
Extension without change of a currently approved collection | 2023-11-24 | |
Approved without change |
Extension without change of a currently approved collection | 2021-06-17 | |
Approved without change |
Revision of a currently approved collection | 2019-03-19 | |
Approved without change |
Extension without change of a currently approved collection | 2018-07-31 | |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2017-05-10 | |
Approved with change |
Extension without change of a currently approved collection | 2015-05-29 | |
Approved with change |
Revision of a currently approved collection | 2012-04-30 | |
Approved without change |
Extension without change of a currently approved collection | 2011-02-28 | |
Approved without change |
Extension without change of a currently approved collection | 2007-09-27 | |
Approved with change |
New collection (Request for a new OMB Control Number) | 2005-11-04 |
Federal Enterprise Architecture: Health - Health Care Services
Form CMS-10102 | HCAHPS Survey Instrument (Mail) and Supporting Materials | Fillable Fileable | Form and instruction |
Form CMS-10102 | HCAHPS Survey Instrument (Telephone Script) | Fillable Fileable | Form and instruction |
Form CMS-10102 | HCAHPS Survey Instrument (AVIR Script) | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.