Information Collection

1-800-MEDICARE Beneficiary Satisfaction Survey

IC 8763 under ICR 200703-0938-011 · OMB 0938-0919.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0919 can be found here:

Documents and Forms

Document Name Document Type
CMS-10098 OMB Pre-notification Letter.doc Other-Pre-notification Letter
CMS-10098 CMS Beneficiary Satisfaction Survey OMB Pearson Survey Question Master List 03-04 (08.02.07).doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	1-800-MEDICARE Beneficiary Satisfaction Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Pre-notification Letter			CMS-10098 OMB Pre-notification Letter.doc		Yes	Yes	Paper Only
Form	CMS-10098	CMS Beneficiary Satisfaction Survey	OMB Pearson Survey Question Master List 03-04 (08.02.07).doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,032	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,032	-1,368	14,400
Annual IC Time Burden (Hours)	1,629	-171	1,800
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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