OMB control number

CAHPS Hospice Survey CMS-10537)

OMB 0938-1257 · HHS/CMS.

OMB 0938-1257

Hospice currently serves approximately 42% of dying patients in the United States. Medicare covers most hospice patients under a benefit created in 1983 to provide palliative care at the end of life. Despite its 30-year history as a Medicare benefit, to date no single survey has been systematically administered by all hospices across the country to assess experiences of hospice care. This submission requests approval for national implementation of the CAHPS® Hospice Survey and as well as approval for a mode experiment to test for mode effects, if any, when the survey is implemented. The CAHPS® Hospice Survey will sample caregivers of patients who died while under hospice care. Survey administration will start between 2 and 3 months after the death of the patient. The sample will be provided by the hospice program. This information will ultimately be used to improve hospice care throughout the country. The mod experiment is intended to determine what mode effects, if any, are found while implementing the survey. Three modes will be tested: mail-only, telephone-only, and mixed-mode (mail with telephone follow up). The mode experiment will occur simultaneously with the first year of National Implementation of the survey, which is also covered as part of this submission.

The latest form for CAHPS Hospice Survey CMS-10537) expires 2027-11-30 and is listed under ICR 202504-0938-007.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-10537 CAHPS Hospice Survey_Traditional ChineseForm and Instruction
Form CMS-10537 CAHPS Hospice_Vietnamese Survey_Form and Instruction
Form CMS-10537 CAHPS Hospice Survey_Spanish_Form and Instruction
Form CMS-10537 CAHPS Hospice Survey_Simplified Chinese_Form and Instruction
Form CMS-10537 CAHPS Hospice Survey_Russian_Form and Instruction
Form CMS-10537 CAHPS Hospice Survey_Portuguese_Form and Instruction
Form CMS-10537 CAHPS Hospice Survey_PolishForm and Instruction
Form CMS-10537 CAHPS Hospice Survey_Korean_Form and Instruction
Form CMS-10537 Hospice Experience of Care Survey -Form and Instruction
Form CMS-10537 National ImplementationForm and Instruction
CMS-10537_ Hospice Survey OMB_Statement_A _2025 Non-Sub .docxSupporting Statement A
CMS-10537_ Hospice Survey OMB_Statement_A _2025 Non-Sub .docxSupporting Statement A
Hospice Survey OMB_Statement_B.docxSupporting Statement B
Hospice Survey OMB_Statement_B.docxSupporting Statement B
CMS 10537 - Non-Sub Change Request Memo.docxJustification for No Material/Nonsubstantive Change
CMS 10537 - Non-Sub Change Request Memo.docx Justification for No Material/Nonsubstantive Change
CAHPS Hospice.Crosswalk 2025_2_19.xlsxSupplementary Document
National Implementation Form and Instruction
National Implementation Form and Instruction
National Implementation Form and Instruction
National Implementation Form and Instruction
National Implementation Form and Instruction
National Implementation Form and Instruction
National Implementation Form and Instruction
National Implementation Form and Instruction
National Implementation Form and Instruction
National Implementation Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202504-0938-007 No material or nonsubstantive change to a currently approved collection 2025-04-24 Approved without change
202407-0938-002 Revision of a currently approved collection 2024-07-10
202304-0938-011 Extension without change of a currently approved collection 2023-04-18 Approved without change
202005-0938-014 Revision of a currently approved collection 2020-06-01 Approved without change
201708-0938-006 Revision of a currently approved collection 2017-08-07 Approved without change
201705-0938-002 Revision of a currently approved collection 2017-05-04 Comment filed on proposed rule and continue
201408-0938-015 New collection (Request for a new OMB Control Number) 2014-08-29 Approved with change