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

View Information Collection (IC)

Medicare Health Outcomes Survey (HOS) and Supporting Regulations at 42 CFR 422.152 (CMS-10203)
 
No Modified
 
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 EG Yes Yes Paper Only
Form and Instruction CMS-10203 SP Yes Yes Paper Only
Form and Instruction CMS-10203 CH Yes Yes Paper Only
Form and Instruction CMS-10203 EGM Yes Yes Paper Only
Form and Instruction CMS-10203 SPM Yes Yes Paper Only
Form and Instruction CMS-10203 CHM Yes Yes Paper Only

Health Health Care Services

 

320,040 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 320,040 0 0 318,471 0 1,569
Annual IC Time Burden (Hours) 105,613 0 0 -323,985 0 429,598
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Response Rate Table 01/24/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.