View Information Collection Request (ICR) Package
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View ICR - Agency Submission
OMB Control No:
0938-0926
ICR Reference No:
202509-0938-017
Status:
Received in OIRA
Previous ICR Reference No:
202507-0938-021
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CM-CPC
Title:
National Implementation of In-Center Hemodialysis CAHPS Survey (CMS-10105)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
Date Submitted to OIRA:
11/26/2025
Requested
Previously Approved
Expiration Date
36 Months From Approved
01/31/2026
Responses
207,500
190,000
Time Burden (Hours)
41,500
51,300
Cost Burden (Dollars)
0
0
Abstract:
CMS designed the ICH CAHPS survey and measures to enable dialysis patients to make more informed decisions when choosing a dialysis facility, to aid facilities in their quality improvement efforts, and to help CMS monitor the performance of dialysis facilities. CMS publicly reports clinical quality measures and patient experience of care survey results for kidney dialysis centers on Care Compare on Medicare.gov. Public reporting of ICH CAHPS data is refreshed in April and October, with each refresh including a rolling average of the two most recent survey periods available. Both clinical and patient experience of care quality measures enable patients with end-stage renal disease (ESRD) to make informed decisions when choosing a dialysis facility. The ICH CAHPS survey fulfills a requirement of the ESRD Quality Incentive Program (QIP).
Authorizing Statute(s):
US Code:
42 USC 1881(h)
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AV52
Final or interim final rulemaking
90 FR 53068
11/24/2025
Federal Register Notices & Comments
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
In-Center Hemodialysis CAHPS Survey: National Implementation
CMS-10105, CMS-10105, CMS-10105, CMS-10105, CMS-10105, CMS-10105
Medicare In-Center Hemodialysis Survey (English)
,
Medicare In-Center Hemodialysis Survey (Spanish)
,
Medicare In-Center Hemodialysis Survey (Samoan)
,
Medicare In-Center Hemodialysis Survey (Simplified Chinese)
,
Medicare In-Center Hemodialysis Survey (Traditional Chinese)
,
Medicare In-Center Hemodialysis Survey (Vietnamese)
ICR Summary of Burden
Total Request
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
207,500
190,000
0
17,500
0
0
Annual Time Burden (Hours)
41,500
51,300
0
-9,800
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
Although the average number sampled has increased, the hour burden has decreased from 51,300 in the previous projection to 41,500 due to a reduction in the survey length. The survey has decreased from 16 minutes to 12 minutes. See section B.3. Methods to Maximize Response Rate for more information on the ICH CAHPS Survey response rate.
Annual Cost to Federal Government:
$1,498,000
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]?
Yes
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:
11/26/2025
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