Information Collection Request

CAHPS Hospice Survey CMS-10537)

ICR 202304-0938-011 · OMB 0938-1257 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1257 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10537 National Implementation Form and Instruction	Modified
CMS-10537 Hospice Survey OMB_Statement_B _.docx Supporting Statement B	2023-04-17
CMS-10537 Hospice Survey _Statement_A_.docx Supporting Statement A	2023-04-17
Attachment_B_Case_Mix_Adjustment_Hospcie_CAHPS.pdf Supplementary Document	2020-07-01
cahps-hospice-survey-quality-assurance-guideline-v6.0---september-2019.pdf Supplementary Document	2020-07-01

IC Document Collections

IC ID	Document Title	Status
212899	National Implementation Form and Instruction	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CMS
OMB Control No	0938-1257
Type of Information Collection	Extension without change of a currently approved collection
Previous ICR Reference No	202005-0938-014
Agency Tracking No	CPI
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31