Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Survey

Generic Customer Satisfaction

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0236 can be found here:

Documents and Forms

Document Name Document Type
Form 0 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Survey Form and Instruction
0 cahps child questionnaire CAHPS 4.0H Child Commercial Questionnaire.doc Form and Instruction
CAHPS survey SSB.doc supporting statement b IC Document

Information Collection (IC) Details

IC Title:	Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0	cahps child questionnaire	CAHPS 4.0H Child Commercial Questionnaire.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
supporting statement b	CAHPS survey SSB.doc	05/22/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.