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Medicare Health Outcomes Survey (HOS) and Supporting Regulations at 42 CFR 422.152 (CMS-10203)
 
No Removed
 
Voluntary
 
42 CFR 422.152

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Other: Medicare HOS - Modified 2010 Questionnaire: English Yes Yes Paper Only
Other- Other: Medicare HOS - Modified 2010 Questionnaire: Spanish Yes Yes Paper Only
Other- Other: Medicare HOS - Modified 2010 Questionnaire: Chinese Yes Yes Paper Only
Other- Other: Other: Medicare HOS - Modified 2010 Questionnaire: English Yes Yes Paper Only
Other- Other: Other: Medicare HOS - Modified 2010 Questionnaire: Spanish Yes Yes Paper Only
Other- Other: Other: Medicare HOS - Modified 2010 Questionnaire: Chinese Yes Yes Paper Only

Health Health Care Services

 

1,099,560 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 0 0 -1,099,560 0 0 1,099,560
Annual IC Time Burden (Hours) 0 0 -366,520 0 0 366,520
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment3 08/25/2010
Attachment1 08/25/2010
Attachment2 08/25/2010
Attachment5a 08/25/2010
Attachment8 08/25/2010
AttachmentsTOC 08/25/2010
Attachment5b 08/25/2010
Attachment7a 08/25/2010
Attachment7b 08/25/2010
Attachment7c 08/25/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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