OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Gen-IC #2 : HCAHPS Mode Experiment

IC 247130 under ICR 201904-0938-010 · OMB 0938-1370.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Gen-IC #2 : HCAHPS Mode Experiment CM-CPC
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10694 HCAHPS Survey Mode HCAHPS Survey for Mode Experiment.docx Yes Yes Fillable Printable

Health Health Care Services

 

7,801 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,801 0 7,801 0 0 0
Annual IC Time Burden (Hours) 1,398 0 1,398 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement GenIC#2 Generic Supporting Statement Testing of Web Survey.docx 05/03/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.