Information Collection

Parts C and D Complaints Resolution Performance Measures (CMS-10308)

IC 193233 under ICR 201006-0938-004 · OMB 0938-1107.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1107 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10308 Parts C and D Complaints Resolution Performance Measures (CMS-10308)	Form and Instruction
CMS-10308 Parts C and D Complaint Closure Beneficiary Survey CR_OMB SurveyInstrument 100520.pdf	Form and Instruction
CR_OMB Advance Letter 100520.pdf CR_OMB Advance Letter 100520	IC Document
CR_OMB Explanations for Inclusion of Survey Qs 100520.pdf CR_OMB Explanations for Inclusion of Survey Qs 100520	IC Document

IC Title:

Parts C and D Complaints Resolution Performance Measures (CMS-10308)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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-10308	Parts C and D Complaint Closure Beneficiary Survey	CR_OMB SurveyInstrument 100520.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,300	5,300
Annual IC Time Burden (Hours)	884	884
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CR_OMB Advance Letter 100520	CR_OMB Advance Letter 100520.pdf	06/10/2010
CR_OMB Explanations for Inclusion of Survey Qs 100520	CR_OMB Explanations for Inclusion of Survey Qs 100520.pdf	06/10/2010

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