Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
HOS Field Test New 6800 2267 0 Form and Instruction CMS-10861 Medicare Health Outcomes Survey (HOS) Field Test Questionnaire Version A
Form and Instruction CMS-10861 Medicare Health Outcomes Survey (HOS) Field Test Questionnaire Version B
Form and Instruction CMS-10861 HOS Field Test Item Differences by Questionnaire
Total burden requested under this ICR: 6800 2267 0  
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