Information Collection

Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: MA & PDP Plan Burden

IC 194256 under ICR 201008-0938-008 · OMB 0938-0732.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0732 can be found here:

Documents and Forms

Document Name Document Type
MA_PD_CAHPS_CrosswalkOMB1_OMB12 (5).doc Other-MA-PDP Survey Crosswalk

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: MA & PDP Plan Burden	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 422.152 42 CFR 422.156 42 CFR 417.472

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-MA-PDP Survey Crosswalk			MA_PD_CAHPS_CrosswalkOMB1_OMB12 (5).doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Privact Act of 1974: hPMS # 09-70-4004	FR Citation: 63 FR 19760

Number of Respondents: 624	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	624	624
Annual IC Time Burden (Hours)	33,696	33,696
Annual IC Cost Burden (Dollars)	3,120,000	3,120,000

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.