National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102)

OMB 0938-0981

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.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10102 HCAHPS Survey (Patients) Form and Instruction
Form CMS-10102 HCAHPS Survey (Patients via Hospital Data Collection) Form and Instruction
CMS-10102 SUPPORTING STATEMENT B - 03-07-24.docx Supporting Statement B
CMS-10102 SUPPORTING STATEMENT A 8-27-24.docx Supporting Statement A
HCAHPS Survey (Patients) Form and Instruction
HCAHPS Survey (Patients via Hospital Data Collection) Form and Instruction

All Historical Document Collections

202408-0938-037	Revision of a currently approved collection	2024-08-28
202404-0938-026 Comment filed on proposed rule and continue	Revision of a currently approved collection	2024-05-02
202311-0938-009 Approved without change	Extension without change of a currently approved collection	2023-11-24
202106-0938-008 Approved without change	Extension without change of a currently approved collection	2021-06-17
201903-0938-006 Approved without change	Revision of a currently approved collection	2019-03-19
201807-0938-015 Approved without change	Extension without change of a currently approved collection	2018-07-31
201705-0938-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2017-05-10
201505-0938-013 Approved with change	Extension without change of a currently approved collection	2015-05-29
201204-0938-008 Approved with change	Revision of a currently approved collection	2012-04-30
201102-0938-015 Approved without change	Extension without change of a currently approved collection	2011-02-28
200709-0938-009 Approved without change	Extension without change of a currently approved collection	2007-09-27
200511-0938-005 Approved with change	New collection (Request for a new OMB Control Number)	2005-11-04

OMB Details

HCAHPS Survey (Patients)

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.