OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Mail Survey of Medicare Advantage Special Needs Plans / Focus Groups with Enrollees of Medicare Advantage SNPs

IC 45542 under ICR 200610-0938-005 · OMB 0938-1010.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Mail Survey of Medicare Advantage Special Needs Plans / Focus Groups with Enrollees of Medicare Advantage SNPs
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10194 SNP-OMB Appx C FocusGroupBeneForm SNP-OMB Appx C FocusGroupBeneForm.pdf No No Paper Only
Form and Instruction CMS-10194 FocuGroupModeratorGuide SNP-OMB Appx B FocuGroupModeratorGuide.pdf No No Paper Only
Form and Instruction CMS-10194 SNP-OMB Appx C Focus Group Bene Form CMS-10194 REVISED SNP-OMB Appx C FocusGroupBeneForm.doc No   Paper Only

Health Health Care Services

 

150 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 150 0 150 0 0 0
Annual IC Time Burden (Hours) 225 0 225 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.