OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Emergency Room Patient Experiences with Care Survey

OMB 0938-1209 · HHS/CMS.

OMB 0938-1209

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10461 Emergency Department Patient Experience of Care Survey Form
OMB Supporting Statement B rev 4-25-13 CLEAN.docx Supporting Statement B
Response to Comments to OMB_ED survey.doc Supplementary Document
508 ATTACHMENT F ER Patient Experience Initial Letter Admitted HCAHPS Add-on.pdf Supplementary Document
508 ATTACHMENT E ER Patient Experience Initial Letter Admitted Stand Alone.pdf Supplementary Document
508 ATTACHMENT D ER Patient Experience Initial Letter Discharged To Community.pdf Supplementary Document
CMS-10461 - Supporting Statement part A rev 4-19-2013 with responses CLEAN.docx Supporting Statement A
Emergency Department Patient Experience of Care Survey Form

All Historical Document Collections

201305-0938-001

Approved without change

New collection (Request for a new OMB Control Number)

2013-05-01