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View Information Collection (IC)

View Information Collection (IC)

Medicare Health Outcomes Survey (HOS) and Supporting Regulations 42 CFR 422.152
 
No New
 
Voluntary
 
42 CFR 422.152

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10203 Yes Yes Fillable Fileable
Form and Instruction CMS-10203 Yes Yes Fillable Fileable

Health Health Care Services

 

2,352 0
   
Individuals or Households
 
   0 %

  Approved 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 666,120 0 666,120 0 0 0
Annual IC Time Burden (Hours) 219,820 0 219,820 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Table of Contents 08/14/2012
Publications 08/14/2012
Mailing Mater Associated with Medicare HOS (English and Spanish) 08/14/2012
Mailing Material Associated with Medicare HOS-Modified (English) 08/14/2012
Response Rate Table 08/14/2012
Crosswalk 08/14/2012
Covariates Used in the Case Mix Adjustments of PCS and MCS Measures 08/14/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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