OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

National Implementation of the Hospice Experience of Care Survey (CAHPs Hospice Survey)

ICR 201408-0938-015 · OMB 0938-1257 · Historical Active

Forms and Documents
Document
Name
Status
Form and Instruction
 New
Supplementary Document
2014-11-14
Supplementary Document
2014-11-14
Supplementary Document
2014-11-14
Supplementary Document
2014-11-14
Supporting Statement B
2014-11-14
Supporting Statement A
2014-11-14
IC Document Collections
IC ID
Document
Title
Status
212900
New
212899 New
ICR Details
0938-1257 201408-0938-015
Historical Active
HHS/CMS
National Implementation of the Hospice Experience of Care Survey (CAHPs Hospice Survey)
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 11/17/2014
Retrieve Notice of Action (NOA) 08/29/2014
  Inventory as of this Action Requested Previously Approved
11/30/2017 36 Months From Approved
561,026 0 0
98,179 0 0
0 0 0
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.
PL: Pub.L. 111 - 148 3004 Name of Law: Affordable Care Act
  
None
0938-AS10 Final or interim final rulemaking 79 FR 49854 08/22/2014
  79 FR 26537 05/08/2014
79 FR 51569 08/29/2014
No
2
IC Title Form No. Form Name
Mode Experiment
National Implementation CMS-10537 Hospice Experience of Care Survey
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 561,026 0 0 561,026 0 0
Annual Time Burden (Hours) 98,179 0 0 98,179 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
This is a new information collection request.
$2,184,375
No
No
Yes
No
No
Uncollected
William Parham 4107864669
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/29/2014