Medicare Health Outcomes Survey Field Test (CMS-10861)

OMB 0938-1464

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10861 HOS Field Test Form and Instruction
CMS-10861 - Supporting Statement B.docx Supporting Statement B
CMS-10861 - Supporting Statement A_.docx Supporting Statement A
Response to comments_cms_60-day.docx Supplementary Document
HOS Field Test Form and Instruction

All Historical Document Collections

202512-0938-008	Revision of a currently approved collection	2025-12-08
202310-0938-006 Approved with change	New collection (Request for a new OMB Control Number)	2023-10-27