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Federal forms, ICRs, and supporting documents

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
Document Name
Document Type
Form and Instruction
Other-Trk Change Version
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

The Annual Medicare Contractor Provider Satisfaction Survey (MCPSS): (CMS-10097)
 
No Modified
 
Voluntary
 
42 CFR 421.120 42 CFR 421.122 42 CFR 421.201

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

Health Health Care Services

 

25,000 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   15 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 25,000 0 0 0 0 25,000
Annual IC Time Burden (Hours) 9,349 0 0 0 0 9,349
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.