View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0701
ICR Reference No:
202501-0938-006
Status:
Active
Previous ICR Reference No:
202104-0938-016
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CM-CPC
Title:
Medicare Health Outcomes Survey (HOS) (CMS-10203)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/22/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/14/2025
Terms of Clearance:
Prior to the re-submission of the information collection “Medicare Health Outcomes Survey (HOS) (CMS-10203)” (0938-0701), the agency will assess and reduce respondent burden and any duplicative information with other collections such as information already collected in a patient's health records. This assessment will be guided by the principles and priorities set forth in the Executive Order 14295 Unleashing Prosperity Through Deregulation (January 31, 2025). https://www.federalregister.gov/documents/2025/02/06/2025-02345/unleashing-prosperity-through-deregulation
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2027
36 Months From Approved
07/31/2025
Responses
663,150
0
629,280
Time Burden (Hours)
212,208
0
201,370
Cost Burden (Dollars)
0
0
0
Abstract:
The Centers for Medicare & Medicaid Services collects quality performance measures in order to hold the Medicare managed care industry accountable for the care being delivered, to enable quality improvement, and to provide quality information to Medicare beneficiaries in order to promote an informed choice. It is critical to CMS's mission that we collect and disseminate information that can be used to help beneficiaries choose among health plans, contribute to improved quality of care through identification of improvement opportunities, and assist CMS in carrying out its oversight and purchasing responsibilities.
Authorizing Statute(s):
US Code:
42 USC 442, Subpart D
PL:
Pub.L. 108 - 173 722(a)(3)(A)(i)
Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
89 FR 81917
10/09/2024
30-day Notice:
Federal Register Citation:
Citation Date:
90 FR 9032
01/14/2025
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Medicare Health Outcomes Survey (HOS)
CMS-10203, CMS-10203, CMS-10203, CMS-10203, CMS-10203, CMS-10203, CMS-10203, CMS-10203
Medicare Health Outcomes Survey
,
Medicare Health Outcomes Survey-Modified (HOS-M)
,
Medicare Health Outcome Survey (Chinese)
,
Medicare Health Outcome Survey (Russian)
,
Medicare Health Outcome Survey (Spanish)
,
Medicare Health Outcomes Survey-Modified (Chinese)
,
Medicare Health Outcomes Survey-Modified (Russian)
,
Medicare Health Outcomes Survey-Modified (Spanish)
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
663,150
629,280
0
33,870
0
0
Annual Time Burden (Hours)
212,208
201,370
0
10,838
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Burden has increased due to the to changes in the number of MAOs required to administer the HOS and the number of PACE plans required to administer the HOS-M, as well as a lower average Baseline response rate. The increase in the number of contracts required to report HOS Baseline and Follow-Up in 2020 was largely due to changes in the number of MA contracts since the last submission. The burden adjustments on PACE plans are a result of changes in the number of PACE plans required to report HOS-M. The number of PACE plans required to administer the HOS-M increased by 22 since the last OMB package.
Annual Cost to Federal Government:
$3,000,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Stephan McKenzie 410 786-1943 stephan.mckenzie@cms.hhs.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
01/14/2025
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