Patient Files

CAHPS Home Health Care Survey (CMS-10275)

Documents and Forms

Document Name Document Type
CMS-10275. Attachment E_Chapter 4 of the HHCAHPS Protocols & Guidelines Manual.pdf Instruction

Information Collection (IC) Details

IC Title:	Patient Files	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 484.250

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10275. Attachment E_Chapter 4 of the HHCAHPS Protocols & Guidelines Manual.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,221	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	98,652	-7,176	105,828
Annual IC Time Burden (Hours)	197,304	-14,352	211,656
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.