Information Collection Request

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

ICR 202402-0938-009 · OMB 0938-1240 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1240 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10500 HOPDs/ASCs Patient Records Form and Instruction	Modified
Form CMS-10500 National Implementation Form	Modified
CMS-10500-SupportingStatement-A.docx Supporting Statement A	2024-02-27
CMS-10500-SupportingStatement-B.docx Supporting Statement B	2024-02-23
Attachment G - Response to Comments.pdf Supplementary Document	2024-02-23

IC Document Collections

IC ID	Document Title	Status
216391	HOPDs/ASCs Patient Records Form and Instruction	Modified
216390	National Implementation Form	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CMS
OMB Control No	0938-1240
Type of Information Collection	Extension without change of a currently approved collection
Previous ICR Reference No	202107-0938-015
Agency Tracking No	CM-CPC
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31