Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
HCAHPS Survey (Patients via Hospital Data Collection) Modified 4450 4450 0 Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) and Supporting Materials
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Telephone Script)
Form and Instruction CMS-10102 HCAHPS Survey Translation - Spanish
Form and Instruction CMS-10102 HCAHPS Survey Translation - Chinese
Form and Instruction CMS-10102 HCAHPS Survey Translation - Russian
Form and Instruction CMS-10102 HCAHPS Survey Translation - Vietnamese
Form and Instruction CMS-10102 HCAHPS Survey Translation - Portuguese
Form and Instruction CMS-10102 HCAHPS Survey Translation - German
Form and Instruction CMS-10102 HCAHPS Survey Translation - Tagalog
Form and Instruction CMS-10102 HCAHPS Survey Translation - Arabic
HCAHPS Survey (Patients) Modified 2300000 277916 0 Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) and Supporting Materials
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Telephone Script)
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Spanish
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Chinese
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Russian
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Vietnamese
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Portuguese
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - German
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Tagalog
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Arabic
Total burden requested under this ICR: 2304450 282366 0  
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