Information Collection

Medicare CAHPS Disenrollment Surveys and Supporting Regs. in 42 CFR 417.126, 417.470, 422.64, and 422.210

IC 8536 under ICR 200507-0938-004 · OMB 0938-0779.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Medicare CAHPS Disenrollment Surveys and Supporting Regs. in 42 CFR 417.126, 417.470, 422.64, and 422.210

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-R-295				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 44,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	44,200	-46,040	90,240
Annual IC Time Burden (Hours)	18,564	-23,548	42,112
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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

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