Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
In-Center Hemodialysis CAHPS Survey: National Implementation Modified 207500 41500 0 Other-Sample Cover Letter (English)
Other-Sample Cover Letter (English)
Form and Instruction CMS-10105 Medicare In-Center Hemodialysis Survey (English)
Other-Sample Cover Letter (Spanish
Other-Sample Cover Letter (Spanish
Form and Instruction CMS-10105 Medicare In-Center Hemodialysis Survey (Spanish)
Other-Other: Sample Cover Letter (Samoan)
Form and Instruction CMS-10105 Medicare In-Center Hemodialysis Survey (Samoan)
Other-Other: Other: Sample Cover Letter (Simple Chinese
Form and Instruction CMS-10105 Medicare In-Center Hemodialysis Survey (Simplified Chinese)
Other-Other: Sample Cover Letter (Traditional Chinese)
Form and Instruction CMS-10105 Medicare In-Center Hemodialysis Survey (Traditional Chinese)
Other-Other: Other: Sample Cover Letter (Vietnamese)
Form and Instruction CMS-10105 Medicare In-Center Hemodialysis Survey (Vietnamese)
Other-Sample Cover Letter (Samoan)
Other-Sample Cover Letter (Simple Chinese)
Other-Sample Cover Letter (Traditional Chinese)
Other-Other Sample Cover Letter (Vietnamese)
Total burden requested under this ICR: 207500 41500 0  
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