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

View Information Collection (IC)

In-Center Hemodialysis CAHPS Survey: National Implementation
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Sample Cover Letter (English) No   Paper Only
Other-Sample Cover Letter (English) No   Paper Only
Form and Instruction CMS-10105 Yes Yes Fillable Printable
Other-Sample Cover Letter (Spanish No   Paper Only
Other-Sample Cover Letter (Spanish No   Paper Only
Form and Instruction CMS-10105 Yes Yes Fillable Printable
Other-Other: Sample Cover Letter (Samoan) No   Paper Only
Form and Instruction CMS-10105 Yes Yes Fillable Printable
Other-Other: Other: Sample Cover Letter (Simple Chinese No   Paper Only
Form and Instruction CMS-10105 Yes Yes Fillable Printable
Other-Other: Sample Cover Letter (Traditional Chinese) No   Paper Only
Form and Instruction CMS-10105 Yes Yes Fillable Printable
Other-Other: Other: Sample Cover Letter (Vietnamese) No   Paper Only
Form and Instruction CMS-10105 Yes Yes Fillable Printable

Health Health Care Services

 

95,000 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 190,000 0 0 -17,000 0 207,000
Annual IC Time Burden (Hours) 51,300 0 0 -4,590 0 55,890
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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