Information Collection

Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: Stand Alone PDP Survey (CMS-R-246)

IC 194258 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
PDP_CAHPS_CrosswalkOMB1_OMB12 (5).doc	Other-Stand Alone PDP Survey

IC Title:

Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: Stand Alone PDP Survey (CMS-R-246)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 423.156

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-Stand Alone PDP Survey			PDP_CAHPS_CrosswalkOMB1_OMB12 (5).doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act of 1974: HPMS # 09-07-4004

FR Citation: 63 FR 19760

Number of Respondents: 81,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	81,000	81,000
Annual IC Time Burden (Hours)	20,250	20,250
Annual IC Cost Burden (Dollars)	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.