PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
HOS Field Test
Modified
6800
1700
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
1700
0
To view an IC, click on IC Title
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