Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CAHPS Home Health Care Survey (CMS-10275) Modified 2967000 593400 0 Form CMS-10275 CAHPS Home Health Care Survey
Form CMS-10275 CAHPS Home Health Care Survey (Russian)
Form CMS-10275 CAHPS Home Health Care Survey (Spanish)
Form CMS-10275 CAHPS Home Health Care Survey (Telephone/Proxy)
Form CMS-10275 CAHPS Home Health Care Survey (Telephone)
HHCAHPS Participation Exemption Request Form New 2000 1160 0 Form CMS-10275 HHCAHPS Participation Exemption Request Form
Patient Assessment Data Modified 9890 158240 0
Total burden requested under this ICR: 2978890 752800 0  
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