View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

HHCAHPS Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10275 5. Attachment C_Proposed HHCAHPS Survey questionnaire all languages (final rule) 5. Attachment C_Proposed HHCAHPS Survey questionnaire all languages (final rule).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,025,894 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,025,894 0 -17,553 0 0 1,043,447
Annual IC Time Burden (Hours) 153,884 0 -54,805 0 0 208,689
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
6.CMS-10275. Attachment D.1_1stEnglishSurveyCoverLetter (final rule) 6.CMS-10275. Attachment D.1_1stEnglishSurveyCoverLetter (final rule).pdf 12/02/2025
7. CMS-10275. Attachment D.2_2ndEnglishSurveyCoverLetter_(final rule) 7. CMS-10275. Attachment D.2_2ndEnglishSurveyCoverLetter_(final rule).pdf 12/02/2025
8. CMS-10275. Attachment D.3_ProxyTelephoneScriptEnglish_(final rule) 8. CMS-10275. Attachment D.3_ProxyTelephoneScriptEnglish_(final rule).pdf 12/02/2025
9. CMS-10275. Attachment D.4_StandardTelephoneScriptEnglish_(final rule) 9. CMS-10275. Attachment D.4_StandardTelephoneScriptEnglish_(final rule).pdf 12/02/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.