Information Collection

Data Collection to Support Policy Analysis of Choices Offered to Medicare + Choice Enrollees and Choices Made by Enrollees

IC 8640 under ICR 200106-0938-001 · OMB 0938-0838.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0838 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Data Collection to Support Policy Analysis of Choices Offered to Medicare + Choice Enrollees and Choices Made by Enrollees	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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	HCFA-10033				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	1,600	1,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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