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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 UPD Attachment 4a - 12022010 HOS 2011 English Questionnaire FINAL.pdf Yes Yes Paper Only
Other- Other: Medicare HOS - Modified 2010 Questionnaire: Spanish UPD Attachment 4b - 12072010 HOS 2011 Spanish Questionnaire.pdf Yes Yes Paper Only
Other- Other: Medicare HOS - Modified 2010 Questionnaire: Chinese UPD Attachment 4c - 12082010 HOS 2011 Chinese Questionnaire.pdf Yes Yes Paper Only
Other- Other: Other: Medicare HOS - Modified 2010 Questionnaire: English UPD Attachment 6a - 12022010 HOS-M 2011 English Questionnaire.pdf Yes Yes Paper Only
Other- Other: Other: Medicare HOS - Modified 2010 Questionnaire: Spanish UPD Attachment 6b - 12072010 HOS-M Questionnaire Spanish.pdf Yes Yes Paper Only
Other- Other: Other: Medicare HOS - Modified 2010 Questionnaire: Chinese UPD Attachment 6c - HOS-M 2011 Chinese Questionnaire_Revised Dec 2010 (2).pdf 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 Attachment3.pdf 08/25/2010
Attachment1 Attachment1.pdf 08/25/2010
Attachment2 Attachment2.pdf 08/25/2010
Attachment5a Attachment5a.pdf 08/25/2010
Attachment8 Attachment8.pdf 08/25/2010
AttachmentsTOC AttachmentsTOC.pdf 08/25/2010
Attachment5b Attachment5b.pdf 08/25/2010
Attachment7a Attachment7a.pdf 08/25/2010
Attachment7b Attachment7b.pdf 08/25/2010
Attachment7c Attachment7c.pdf 08/25/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.