Information Collection

The Annual Medicare Contractor Provider Satisfaction Survey (MCPSS): (CMS-10097)

IC 8757 under ICR 201009-0938-001 · OMB 0938-0915.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10097 The Annual Medicare Contractor Provider Satisfaction Survey (MCPSS): (CMS-10097)	Form and Instruction
2010 MCPSS Instrument(Track Changes).doc	Other-Trk Change Version
CMS-10097 Medicare Contractor Provider Satisfaction Survey 2010 2010 MCPSS Instrument Modified 7-21-10.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 421.120 42 CFR 421.122 42 CFR 421.201

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-10097	Medicare Contractor Provider Satisfaction Survey 2010	2010 MCPSS Instrument Modified 7-21-10.docx		Yes	Yes	Paper Only
Other-Trk Change Version			2010 MCPSS Instrument(Track Changes).doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 15 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	25,000	25,000
Annual IC Time Burden (Hours)	9,349	9,349
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.