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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.