View Information Collection (IC)

View Information Collection (IC)

IC Title:	CAHPS for MIPS Survey Beneficiary Participation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 414.1330 and 414.1335

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10450	Mail Survey	Appendix-B1-2024-mail-survey.pdf		Yes	Yes	Fillable Fileable
Instruction			Appendix-C1-2024-survey-initial-cover-letter.pdf		Yes	Yes	Fillable Fileable
Instruction			Appendix-D1-2024-survey-second-cover-letter.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10450	CAHPS for MIPS CATI Script	Appendix-E1-2024-CATI-script.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	25,500	0	-4,452	0	0	29,952
Annual IC Time Burden (Hours)	5,567	0	-973	0	0	6,540
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.