Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
HOPDs/ASCs Patient Records Modified 10243 286804 0 Form and Instruction CMS-10500 OAS CAHPS (Mail Survey)
Form CMS-10500 OAS CAHPS (Telephone Script)
Form and Instruction CMS-10500 OAS CAHPS (Web Survey Screenshots)
Form and Instruction CMS-10500 OAS CAHPS - Spanish
Form and Instruction CMS-10500 OAS CAHPS - ChineseSimplified.
Form and Instruction CMS-10500 OAS CAHPS - ChineseTraditional
Form and Instruction CMS-10500 OAS CAHPS - Korean
Form and Instruction CMS-10500 OAS CAHPS - Russian
National Implementation Modified 2524400 328172 0 Form CMS-10500 OAS CAHPS (Mail Survey)
Form and Instruction CMS-10500 OAS CAHPS (Telephone Script)
Form and Instruction CMS-10500 OAS CAHPS (Web Survey Screenshots)
Form and Instruction CMS-10500 OAS CAHPS - Spanish
Form and Instruction CMS-10500 OAS CAHPS - ChineseSimplified
Form and Instruction CMS-10500 OAS CAHPS - ChineseTraditional
Form and Instruction CMS-10500 OAS CAHPS - Korean
Form and Instruction CMS-10500 OAS CAHPS - Russian
Total burden requested under this ICR: 2534643 614976 0  
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