Information Collection

MSInteractive Survey Tool for www.medicare.gov

IC 8471 under ICR 200803-0938-006 · OMB 0938-0756.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0756 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-268 MSInteractive Survey Tool for www.medicare.gov	Form and Instruction
CMS-R-268 MSInteractive Survey Tool for www.medicare.gov CMS-R-268.Collection Instrument-Final.doc	Form and Instruction

IC Title:

MSInteractive Survey Tool for www.medicare.gov

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
Form and Instruction	CMS-R-268	MSInteractive Survey Tool for www.medicare.gov	CMS-R-268.Collection Instrument-Final.doc		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,900

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	4,900	-2,100	7,000
Annual IC Time Burden (Hours)	817	234	583
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.