OMB control number

National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey (CMS-10500)

OMB 0938-1240 · HHS/CMS.

OMB 0938-1240

The information collected in the national implementation of OAS CAHPS will be used for the following purposes: -To provide a source of information from which selected measures can be publicly reported to beneficiaries to help them make informed decisions for outpatient surgery facility selection; -To aid facilities with their internal quality improvement efforts and external benchmarking with other facilities; and -To provide CMS with information for monitoring and public reporting purposes. For the mode experiment, CMS plans to use information from this mode experiment to determine whether additional mode of administration (i.e. Web data collection) should be included in the current national implementation of OAS CAHPS protocols.

The latest form for National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey (CMS-10500) expires 2026-11-30 and is listed under ICR 202402-0938-009.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10500 OAS CAHPS - Russian	Form and Instruction
Form CMS-10500 OAS CAHPS - Korean	Form and Instruction
Form CMS-10500 OAS CAHPS (Web Survey Screenshots) (Spanish)	Form and Instruction
Form CMS-10500 OAS CAHPS (Telephone Script) (Spanish)	Form and Instruction
Form CMS-10500 OAS CAHPS - Spanish	Form and Instruction
Form CMS-10500 OAS CAHPS (Web Survey Screenshots)	Form and Instruction
Form CMS-10500 OAS CAHPS (Telephone Script)	Form and Instruction
Form CMS-10500 OAS CAHPS (Mail Survey)	Form and Instruction
Form CMS-10500 OAS CAHPS Survey Instrument_Web_Spanish	Form and Instruction
Form CMS-10500 OAS CAHPS Survey Instrument_Telephone_Spanish	Form and Instruction
Form CMS-10500 OAS CAHPS - Spanish	Form and Instruction
Form CMS-10500 OAS CAHPS (Web Survey Screenshots)	Form and Instruction
Form CMS-10500 OAS CAHPS (Telephone Script)	Form and Instruction
Form CMS-10500 OAS CAHPS (Mail Survey)	Form and Instruction
CMS-10500-SupportingStatement-A.docx	Supporting Statement A
CMS-10500-SupportingStatement-B.docx	Supporting Statement B
Attachment F - OAS CAHPS Crosswalk.docx (document unavailable)	Supplementary Document
HOPDs/ASCs Patient Records	Form and Instruction
HOPDs/ASCs Patient Records	Form and Instruction
HOPDs/ASCs Patient Records	Form and Instruction
HOPDs/ASCs Patient Records	Form and Instruction
HOPDs/ASCs Patient Records	Form and Instruction
HOPDs/ASCs Patient Records	Form and Instruction
HOPDs/ASCs Patient Records	Form and Instruction
HOPDs/ASCs Patient Records	Form and Instruction
HOPDs/ASCs Patient Records	Form and Instruction
Individuals	Form and Instruction
Individuals	Form and Instruction
Individuals	Form and Instruction
Individuals	Form and Instruction
Individuals	Form and Instruction
Individuals	Form and Instruction
Individuals	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202602-0938-015	Revision of a currently approved collection	2026-02-19
202402-0938-009	Extension without change of a currently approved collection	2024-02-27	Approved without change
202107-0938-015	Revision of a currently approved collection	2021-07-30	Approved without change
201807-0938-016	Revision of a currently approved collection	2018-07-31	Approved without change
201510-0938-003	No material or nonsubstantive change to a currently approved collection	2015-10-29	Approved with change
201505-0938-003	Revision of a currently approved collection	2015-05-07	Approved with change
201312-0938-022	New collection (Request for a new OMB Control Number)	2013-12-31	Approved with change

OMB Details

National Implementation

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-10500	OAS CAHPS - Russian	Fillable Fileable	Form and instruction
Form CMS-10500	OAS CAHPS - Korean	Fillable Fileable	Form and instruction
Form CMS-10500	OAS CAHPS - ChineseTraditional	Fillable Fileable	Form and instruction
Form CMS-10500	OAS CAHPS - ChineseSimplified	Fillable Fileable	Form and instruction
Form CMS-10500	OAS CAHPS - Spanish	Fillable Fileable	Form and instruction
Form CMS-10500	OAS CAHPS (Web Survey Screenshots)	Fillable Fileable	Form and instruction
Form CMS-10500	OAS CAHPS (Telephone Script)	Fillable Fileable	Form and instruction
Form CMS-10500	OAS CAHPS (Mail Survey)	Fillable Fileable	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.