Outpatient and Ambulatory Surgery Experience of Care Survey

Outpatient and Ambulatory Surgery Experience of Care Survey (CMS-10500)

OMB: 0938-1240

IC ID: 209906

Information Collection (IC) Details

View Information Collection (IC)

Outpatient and Ambulatory Surgery Experience of Care Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10500 Outpatient and Ambulatory Surgery Experience of Care Survey Outpatient and Ambulatory Surgery Experience of Care Survey_Draft_to_OMB_post_60-day_notice_revisions [rev 12-27-13 by OSORA PRA].docx Yes No Fillable Printable
Other-Cover Letter Attachment_B_Cover Letter for First Mailing [5-13-2014].docx No   Paper Only
Form and Instruction CMS-1500 Telephone Interview Script for the Outpatient and Ambulatory Surgery Experience of Care Survey Attachment_C_Introductory Script for Telephone Contact [5-13-2014].docx Yes No Printable Only

Health Health Care Services

 

2,304 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 2,304 2,304 0 0 0 0
Annual IC Time Burden (Hours) 384 384 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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