View Information Collection (IC)

View Information Collection (IC)

HCAHPS Survey (Patients)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) and Supporting Materials Attachment A - 2023_survey-instruments_english_mail.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Telephone Script) Attachment B - 2023_HCAHPS Survey - English_telephone.pdf No   Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Spanish Attachment C - 2023_HCAHPS Survey Translation - Spanish.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Chinese Attachment D - 2023_HCAHPS Survey Translation - Chinese.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Russian Attachment E - 2023_HCAHPS Survey Translation - Russian.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Vietnamese Attachment F - 2023_HCAHPS Survey Translation - Vietnamese.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Portuguese Attachment G - 2023_HCAHPS Survey Translation - Portuguese.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - German Attachment H - 2023_HCAHPS Survey Translation - German.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Tagalog Attachment I - 2023_HCAHPS Survey Translation - Tagalog.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10102 HCAHPS Survey Instrument (Mail) - Arabic Attachment J - 2023_HCAHPS Survey Translation - Arabic.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

2,300,000 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 2,300,000 0 0 -539,017 0 2,839,017
Annual IC Time Burden (Hours) 277,916 0 0 -65,131 0 343,047
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.