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

Medicare Contractor Provider Satisfaction Survey (MCPSS) and Supporting Regulations in 42 CFR 421.120, 421.122 and 421.201

Documents and Forms

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

Information Collection (IC) Details

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

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 %

	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

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.