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

View Information Collection (IC)

Mode Experiment: ICH CAHPS Survey for ICH and Home Dialysis Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10105 Yes Yes Fillable Printable
Form and Instruction CMS-10105 Yes Yes Fillable Printable

Health Health Care Services

 

4,270 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 4,270 0 4,270 0 0 0
Annual IC Time Burden (Hours) 769 0 769 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CoverLetter1- Mail and Mail-Phone 11/06/2026
CoverLetter1-Web-Mail-Phone 11/06/2026
CoverLetter2-Mail 11/06/2026
Prenote Letter-All-Modes 11/06/2026
Web-Email-Invite-Web-Mail-Phone 11/06/2026
Web-Email-Reminder-Web-Mail-Phone 11/06/2026
Web-Invite-by-Mail-Web-Mail-Phone 11/06/2026
CoverLetter1-Mail-and-Mail-Phone-Spanish 11/06/2026
CoverLetter1-Web-Mail-Phone-Spanish 11/06/2026
CoverLetter2-Mail-Spanish 11/06/2026
Prenote Letter-All-modes-Spanish 11/06/2026
Web-Email-Invite-Web-Mail-Phone-Spanish 11/06/2026
Web-Email-Reminder-Web-Mail-Phone-Spanish 11/06/2026
Web-Invite-by-Mail-Web-Mail-Phone-Spanish 11/06/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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