Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Medicare Health Outcomes Survey (HOS) and Supporting Regulations at 42 CFR 422.152 (CMS-10203) Modified 320040 105613 0 Form and Instruction CMS-10203 EG HOS Questionnaire English
Form and Instruction CMS-10203 SP HOS Questionnaire Spanish
Form and Instruction CMS-10203 CH HOS Questionnaire Chinese
Form and Instruction CMS-10203 EGM HOS Modified Questionnaire English
Form and Instruction CMS-10203 SPM HOS Modified Questionnaire Spanish
Form and Instruction CMS-10203 CHM HOS Modified Questionnaire Chinese
Total burden requested under this ICR: 320040 105613 0  
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