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

View Information Collection (IC)

Mode Experiment
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10500 Outpatient and Ambulatory Surgery OAS CAHPS Survey OAS CAHPS_OMB_Attachment_A_OAS CAHPS Survey-04-21-15.docx No   Fillable Printable
Other-Cover Letter OAS CAHPS_OMB_Attachment_B_Cover Letter.docx No   Paper Only
Form and Instruction CMS-1500 Telephone Interview Script for the Outpatient and Ambulatory Surgery OAS CAHPS Survey OAS CAHPS_OMB_Attachment_C_CATI Intro Script_rev (2).docx No   Printable Only

Health Health Care Services

 

4,710 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 4,710 0 2,406 0 0 2,304
Annual IC Time Burden (Hours) 612 0 228 0 0 384
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk OAS CAHPS Crosswalk of Changes to Survey-Letter-Intro.xlsx 05/06/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.