Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Medicare Health Outcomes Survey (HOS) Modified 663150 212208 0 Form CMS-10203 Medicare Health Outcomes Survey
Form CMS-10203 Medicare Health Outcomes Survey-Modified (HOS-M)
Form CMS-10203 Medicare Health Outcome Survey (Chinese)
Form CMS-10203 Medicare Health Outcome Survey (Russian)
Form CMS-10203 Medicare Health Outcome Survey (Spanish)
Form CMS-10203 Medicare Health Outcomes Survey-Modified (Chinese)
Form CMS-10203 Medicare Health Outcomes Survey-Modified (Russian)
Form CMS-10203 Medicare Health Outcomes Survey-Modified (Spanish)
Total burden requested under this ICR: 663150 212208 0  
To view an IC, click on IC Title