OMB control number

Patient-Reported Indicator Survey (PaRIS) (CMS-10792)

OMB 0938-1434 · HHS/CMS.

OMB 0938-1434

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10792 PaRIS Survey Form and Instruction
Form CMS-10792 PaRIS Eligibility Screener Form and Instruction
CMS-10792_0938-NEW_SSB.docx Supporting Statement B
PaRIS_PublicComment_Response.docx Supplementary Document
CMS-10792_0938-NEW_SSA.docx Supporting Statement A
Attach4_PaRISCogTestReport.pdf Supplementary Document
Attach3_PaRIS_FAQs.pdf Supplementary Document
Attach3_PaRIS_ReminderPostcard.pdf Supplementary Document
Attach3_PaRIS_AdvLtr.pdf Supplementary Document
PaRIS Survey Form and Instruction
PaRIS Eligibility Screener Form and Instruction

All Historical Document Collections

202202-0938-004

2022-03-02